Individual
WESTLEY WAYNE GORMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
IDC
Contact information
Practice address
34800 BOB WILSON DR, SAN DIEGO, CA 92134-1098
(619) 532-6400
Mailing address
6219 CALLE PAVANA, SAN DIEGO, CA 92139-2329
(202) 316-2481
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1283869349
MILITARY
—
Enumeration date
06/24/2019
Last updated
06/24/2019
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