Individual
MR. JASON KRISTOPHER MITCHELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
IDC
Contact information
Practice address
34800 BOB WILSON DR, SAN DIEGO, CA 92134-1098
(469) 502-8263
Mailing address
1585 KENWELL ST, SAN DIEGO, CA 92139-1005
(469) 502-8263
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02839649
DRIVERS LICENSE
TX
Enumeration date
02/27/2019
Last updated
02/27/2019
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