Individual
LOGAN TIMOTHY PETERSCHMIDT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
HOSPITAL CORPSMAN
Contact information
Practice address
2051 CUSHING RD, SAN DIEGO, CA 92106-6173
(619) 524-0418
Mailing address
2051 CUSHING RD, SAN DIEGO, CA 92106-6173
Taxonomy
Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
Primary
—
—
Other
Enumeration date
11/29/2017
Last updated
11/29/2017
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