Individual
JERRICSON BARLIS PERALTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
IDC
Contact information
Practice address
402 GOODRICH AVENUE, KITTERY, ME 03904
(207) 438-1781
Mailing address
6850 MISSION GORGE RD APT 1248, SAN DIEGO, CA 92120-2478
(818) 263-5345
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
06/12/2017
Last updated
01/27/2025
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