Facts
- Status
- A
- Credential
- LCSW
- Type
- Individual
- Enumeration date
- 2012-12-08
- Last updated
- 2012-12-08
Specialties
Licenses
- License CA
- 29007
Location
- Practice location
- 17542 17TH ST STE 300
- City
- TUSTIN CA
- Postal code
- 927801960
- Phone
- 714-734-4500
Medicare
- PECOS
- A PECOS enrollment row matches 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.