Facts
- Status
- A
- Type
- Individual
- Enumeration date
- 2019-04-29
- Last updated
- 2020-11-30
Licenses
- License CA
- 119176
Location
- Practice location
- 6147 SUTTER AVE
- City
- CARMICHAEL CA
- Postal code
- 956082738
- Phone
- 916-897-1434
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
Search this city from the state hub for other records in the public registry.
Removal request
Public data from NPPES and CMS. Not a credentialing determination.