Graduated: 2008
NPI: 1053639914
Practice Locations (2)
COUNTY OF LOS ANGELES
7601 IMPERIAL HWY
DOWNEY, CA 902423456
3102225026
COUNTY OF LOS ANGELES
12021 S WILMINGTON AVE, ROOM 1059
LOS ANGELES, CA 900593019
Source: CMS National Downloadable File, September 2026.