Most Relevant Information
Provider Data
| NPI Number: | 1003309410 |
| Provider Name: | GABRIEL JOSE SAN PEDRO IDC |
| Entity Type: | Individual |
| Taxonomy Code: | 1710I1002X |
| Specialty: | Military Health Care Provider |
| License Number: |
Most Important Dates
| Enumeration Date: | 06/11/2018 |
| Last Updated: | 06/11/2018 |
Provider Practice Location
34101 FARENHOLT AVE
SAN DIEGO
CA
921347000
Practice Location Phone/Fax
| Phone: | 6195327968 |
| Fax: |
Provider Mailing Location
34101 FARENHOLT AVE
SAN DIEGO
CA
921347000
Provider Mailing Phone/Fax
| Phone: | 6195327968 |
| Fax: |