Provider Demographics
NPI:1790452761
Name:DEROCHEMONT, HARRY F
Entity Type:Individual
Prefix:
First Name:HARRY
Middle Name:F
Last Name:DEROCHEMONT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1640 CAMINO DEL RIO N STE 881256
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-1506
Mailing Address - Country:US
Mailing Address - Phone:619-317-3207
Mailing Address - Fax:
Practice Address - Street 1:1640 CAMINO DEL RIO N STE 202
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-1523
Practice Address - Country:US
Practice Address - Phone:619-317-3207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-26
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver