Individual
JUSTIN BENTON DAUGHERTY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
IDC
Contact information
Practice address
3124 SALMON ST, SAN DIEGO, CA 92124-3605
(402) 699-7774
Mailing address
3124 SALMON ST, SAN DIEGO, CA 92124-3605
(402) 699-7774
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
11/03/2014
Last updated
11/03/2014
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