NPI 1013264423

Dennis Buenaventura Custodio, INDEPENDENTDUTYHM

Practitioner Independent Duty Corpsman Groton, CT

Practice location

Address: 69 Trout Ave Naval Undersea Medical Institute, Groton, CT 06349
Phone: (253) 905-8239
Mailing address: 6910 227th Street CT E, Spanaway, WA 98387-5841

Registered specialties

Independent Duty Corpsman Primary

Other Service Providers Taxonomy 1710I1002X

Other Military Health Care Provider providers in Connecticut →

Registry record

NPI: 1013264423
Entity type: Individual
Sex (as registered): Male
NPI issued: 6 Aug 2012
Record last updated: 6 Aug 2012

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.