Individual
OMAR ANTONIO PESCADOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
IDC
Contact information
Practice address
SEAL TEAM 10 MEDICAL DEPARTMENT, BLDG 3808, VIRGINIA BEACH, VA 23521
(917) 848-3454
Mailing address
7568 ROARING SPRINGS RD, GLOUCESTER, VA 23061-4269
(917) 848-3454
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
03/06/2012
Last updated
03/06/2012
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