Individual
JHAN DEIVY SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
IDC
Contact information
Practice address
34101 FARENHOLT AVE BLDG 14, SAN DIEGO, CA 92134-7000
(619) 532-7968
Mailing address
3950 MAHAILA AVE APT L24, SAN DIEGO, CA 92122-6134
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
CA
Other
Enumeration date
03/25/2026
Last updated
03/25/2026
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