Jason Kristopher Mitchell, IDC
Military Health Care Provider, Independent Duty Corpsman in San Diego, CA. Individual provider (NPI-1).
NPI number1982161865
StatusActive
Last updated in NPPESFeb 27, 2019
Details
- NPI
- 1982161865
- Entity type
- Individual (NPI-1)
- Name
- Mr. Jason Kristopher Mitchell
- Credential
- IDC
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Feb 27, 2019
- Last updated
- Feb 27, 2019
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1710I1002X | Military Health Care Provider, Independent Duty Corpsman | – | – | Yes |
Practice location
34800 Bob Wilson DrSan Diego, CA 92134-1098
Phone 469-502-8263
Mailing address
1585 Kenwell StSan Diego, CA 92139-1005
Phone 469-502-8263
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