Individual
MR. COLLIN JOHN WISEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
SFIDC
Contact information
Practice address
34101 FARENHOLT AVE, SAN DIEGO, CA 92134-7000
(619) 532-7968
Mailing address
10190 COWELL CT, SAN DIEGO, CA 92124-2905
(443) 510-5803
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
12/11/2017
Last updated
12/11/2017
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