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Individual

MARK NOVAK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
SOIDC

Contact information

Practice address
1ST RECON BN BAS BLDG 4101 41 AREA, CAMP PENDLETON, CA 92055
(224) 343-3623
Mailing address
PO BOX 555584, CAMP PENDLETON, CA 92055-5584

Taxonomy

Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary

Other

Enumeration date
01/26/2021
Last updated
01/26/2021
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