Facts
- Status
- A
- Type
- Individual
- Enumeration date
- 2022-10-28
- Last updated
- 2026-07-17
Licenses
- License CA
- 130855
Location
- Practice location
- 44444 20TH ST W
- City
- LANCASTER CA
- Postal code
- 935342714
- Phone
- 661-951-0070
Medicare
- PECOS
- A PECOS enrollment row matches this NPI.
LEIE
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Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.