Facts
- Status
- A
- Type
- Organization
- Enumeration date
- 2007-02-16
- Last updated
- 2025-09-11
Licenses
- License CA
- G23092
- License CA
- C36017
- License CA
- G36388
Location
- Practice location
- 504 E ALVARADO ST STE 201
- City
- FALLBROOK CA
- Postal code
- 920282364
- Phone
- 760-731-0352
Organization contact
- Name
- BARBARA GORDON
- Title
- Practice Administrator
- Phone
- 7607310352
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.