Graduated: 2022
NPI: 1063152429
Practice Locations (4)
393 E WALNUT ST FL, 5 PHR GROUP PROVIDER ENROLLMENT UNIT
Pasadena, CA 911880001
393 E WALNUT ST 3RD FL
PASADENA, CA 911880001
5651 COPLEY DR
San Diego, CA 921117903
5651 COPLEY DR
SAN DIEGO, CA 921117903
Source: CMS National Downloadable File, September 2026.