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Individual

EDGAR N IBAY

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
IDC

Contact information

Practice address
1992 CAMINITO DE LA CRUZ, CHULA VISTA, CA 91913
(760) 828-3833
Mailing address
1992 CAMINITO DE LA CRUZ, CHULA VISTA, CA 91913
(760) 828-3833

Taxonomy

Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1710-1002X
IDC
Enumeration date
05/13/2013
Last updated
05/13/2013
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