Graduated: 2003
NPI: 1063670859
Practice Locations (2)
SOUTHERN CALIFORNIA PERMANENTE MEDICAL GROUP
9961 SIERRA AVE
FONTANA, CA 923356720
9094275000
SOUTHERN CALIFORNIA PERMANENTE MEDICAL GROUP
9052 CENTRAL AVE
MONTCLAIR, CA 917631621
9096245717
Source: CMS National Downloadable File, September 2026.