Medical school: YALE UNIVERSITY SCHOOL OF MEDICINE
Graduated: 1979
NPI: 1023095320
Practice Locations (3)
PROVIDENCE MEDICAL INSTITUTE
GLENDALE, CA 91202
PROVIDENCE MEDICAL INSTITUTE
LAGUNA NIGUEL, CA 92677
PROVIDENCE MEDICAL INSTITUTE
18370 BURBANK BLVD, SUITE 707
TARZANA, CA 913562830
8183455580
Source: CMS National Downloadable File, September 2026.