Facts
- Status
- A
- Credential
- D.O.
- Type
- Individual
- Enumeration date
- 2007-12-19
- Last updated
- 2019-07-02
Licenses
- License IN
- 02003437A
- License IN
- 02003437A
Location
- Practice location
- NAVAL HOSPITAL, CAMP PENDLETON SANTA MARGARITA ROAD, BLDG H100 ATTN: CODE 094
- City
- CAMP PENDLETON CA
- Postal code
- 920555191
- Phone
- 760-725-1400
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.