Individual
MR. RUBENS HENRIQUE DACOSTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
SOIDC
Contact information
Practice address
2D MARINE SPECIAL OPERATIONS BATTALION, PSC, CAMP LEJEUNE, NC 28542-0183
(910) 440-7704
(910) 440-7059
Mailing address
306 HEADWATERS DR, HAMPSTEAD, NC 28443-2085
(910) 546-3112
(910) 450-4194
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
08/25/2009
Last updated
09/22/2010
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