Individual
MR. BENEDICT JOVELLANO JACOB
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1 HOOPER BLVD, IMPERIAL BEACH, CA 91932-1050
(619) 628-8447
Mailing address
1 HOOPER BLVD, IMPERIAL BEACH, CA 91932-1050
(619) 628-8447
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
01/04/2011
Last updated
01/04/2011
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