Individual
NICHOLAS SCOTT DESHANE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC, CSCS
Contact information
Practice address
520420. ATTN SMART CLINIC, SOI WEST, CAMP PENDLETON, CAMP PENDLETON, CA 92055
(760) 725-7029
Mailing address
3979 32ND ST, SAN DIEGO, CA 92104-2001
(209) 404-6353
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
03/09/2010
Last updated
03/09/2010
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