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1063057149
DERRICK CANNON
SAN BERNARDINO, CA
NPI
1063057149
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
175T00000X Peer Specialist
Enumeration Date
2019-11-12
Last Update Date
2019-11-26
Business Address
DERRICK CANNON
820 E GILBERT ST
SAN BERNARDINO, CA 92415-1403
Phone number: 909-388-5644
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Mailing Address
DERRICK CANNON
201 W MILL ST
SAN BERNARDINO, CA 92408-1403
Phone number: 909-388-5644
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