Facts
- Status
- A
- Credential
- MD
- Type
- Individual
- Enumeration date
- 2007-07-17
- Last updated
- 2014-09-09
Specialties
Licenses
- License CA
- 132342
Location
- Practice location
- 702 MOUNTAIN RANCH ROAD
- City
- SAN ANDREAS CA
- Postal code
- 95249
- Phone
- 209-754-0870
Medicare
- PECOS
- A PECOS enrollment row matches 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.