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1871355974
JACOB BRODY HOOD LAKE
SAN DIEGO, CA
NPI
1871355974
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
1710I1002X Military Health Care Provider, Independent Duty Corpsman
Enumeration Date
2024-01-25
Last Update Date
2024-01-25
Business Address
JACOB BRODY HOOD LAKE IDC
34101 FARENHOLT AVE BLDG 14
SAN DIEGO, CA 92134-7000
Phone number: 757-376-3269
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Mailing Address
JACOB BRODY HOOD LAKE IDC
137 CARNATION AVE
IMPERIAL BEACH, CA 91932-1007
Phone number: 757-376-3269
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