Facts
- Status
- A
- Type
- Individual
- Enumeration date
- 2022-10-21
- Last updated
- 2026-09-18
Specialties
Licenses
- License CA
- Number not in the file
Location
- Practice location
- 7285 QUILL DR
- City
- DOWNEY CA
- Postal code
- 902422001
- Phone
- 562-940-8681
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
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.