Individual
JASON L BROCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
IDC
Contact information
Practice address
2534 TRIDENT WAY, SAN DIEGO, CA 92155-5493
(619) 437-2544
Mailing address
2534 TRIDENT WAY, SAN DIEGO, CA 92155-5493
(619) 437-2544
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
170101002X
CA
Other
Enumeration date
05/27/2009
Last updated
05/27/2009
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