Facts
- Status
- A
- Type
- Individual
- Enumeration date
- 2016-11-16
- Last updated
- 2023-08-12
Specialties
Licenses
The registry row did not include a license.
Location
- Practice location
- 631 S ORCHARD AVE
- City
- UKIAH CA
- Postal code
- 954825011
- Phone
- 707-467-2010
Medicare
- PECOS
- No PECOS enrollment row matched 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.