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1457638546
JOSHUA BRENT DEHAVEN
SAN DIEGO, CA
NPI
1457638546
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
1710I1002X Military Health Care Provider, Independent Duty Corpsman
Enumeration Date
2011-11-03
Last Update Date
2011-11-03
Business Address
-- JOSHUA BRENT DEHAVEN IDC
2642 TRIDENT WAY BLDG 616
SAN DIEGO, CA 92155-5492
Phone number: 331-425-9749
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Mailing Address
-- JOSHUA BRENT DEHAVEN IDC
34101 FARENHOLT AVE BLDG 14
SAN DIEGO, CA 92134-7000
Phone number: 331-425-9749
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