Facts
- Status
- A
- Credential
- Psy.D.
- Type
- Individual
- Enumeration date
- 2013-07-09
- Last updated
- 2013-07-09
Specialties
Licenses
- License CA
- psy23186
Location
- Practice location
- 38139 BALCH PARK RD
- City
- SPRINGVILLE CA
- Postal code
- 932659762
- Phone
- 310-936-3621
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.