Facts
- Status
- A
- Credential
- D.C.
- Type
- Individual
- Enumeration date
- 2015-04-17
- Last updated
- 2025-04-09
Specialties
Licenses
- License CA
- DC33087
Location
- Practice location
- 117 W BELLEVUE DR STE 1
- City
- PASADENA CA
- Postal code
- 911052548
- Phone
- 626-497-8866
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
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Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.