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1104220912
IMHOTEP MUSTAQEEM
SAN DIEGO, CA
NPI
1104220912
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date
2014-10-22
Last Update Date
2014-10-22
Business Address
-- IMHOTEP MUSTAQEEM
3336 STEEL STREET
SAN DIEGO, CA 92113
Phone number: 619-822-7919
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Mailing Address
-- IMHOTEP MUSTAQEEM
3336 STEEL STREET
SAN DIEGO, CA 92113
Phone number: 619-822-7919
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