Facts
- Status
- A
- Credential
- R.D.
- Type
- Individual
- Enumeration date
- 2016-10-24
- Last updated
- 2016-10-24
Specialties
Licenses
- License CA
- 00953806
Location
- Practice location
- 363 N RAPHAEL LN
- City
- CLOVIS CA
- Postal code
- 936116191
- Phone
- 559-835-4011
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.