Facts
- Status
- A
- Type
- Individual
- Enumeration date
- 2006-07-14
- Last updated
- 2007-07-08
Specialties
Licenses
- License CA
- RDH 18476
Location
- Practice location
- 150 TEJAS PL
- City
- NIPOMO CA
- Postal code
- 934449123
- Phone
- 805-938-0935
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
The OIG NPI list is not in this build yet. Confirm on OIG's search.
Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.