Individual
ROCKEY DIAGON BOOC
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
IDC
Contact information
Practice address
3410 FARENHOLT AVE, SAN DIEGO, CA 92134-0001
(504) 419-7424
Mailing address
3410 FARENHOLT AVE, SAN DIEGO, CA 92134-0001
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
IDC
TRICARE
CA
Enumeration date
07/09/2018
Last updated
07/09/2018
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