Matthew John Henry, IDC
Military Health Care Provider, Independent Duty Corpsman in San Diego, CA. Individual provider (NPI-1).
NPI number1548035397
StatusActive
Last updated in NPPESNov 21, 2023
Details
- NPI
- 1548035397
- Entity type
- Individual (NPI-1)
- Name
- Matthew John Henry
- Credential
- IDC
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Nov 21, 2023
- Certification date
- Nov 21, 2023
- Last updated
- Nov 21, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1710I1002X | Military Health Care Provider, Independent Duty Corpsman | – | – | Yes |
Practice location
34101 Farenholt Ave Bldg 14San Diego, CA 92134-7000
Phone 619-548-3754
Mailing address
34101 Farenholt Ave Bldg 14San Diego, CA 92134-7000
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