Facts
- Status
- A
- Type
- Individual
- Enumeration date
- 2016-09-07
- Last updated
- 2024-11-18
Licenses
- License CA
- 119328
Location
- Practice location
- 13507 CHASE ST
- City
- ARLETA CA
- Postal code
- 913315724
- Phone
- 818-941-6206
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.