Facts
- Status
- A
- Type
- Individual
- Enumeration date
- 2013-09-23
- Last updated
- 2013-09-23
Specialties
Licenses
- License CA
- C0058637
Location
- Practice location
- 506 W JACKMAN ST
- City
- LANCASTER CA
- Postal code
- 935342531
- Phone
- 661-726-2850
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.