Medical school: TEMPLE UNIVERSITY SCHOOL OF MEDICINE
Graduated: 1999
NPI: 1083642839
Practice Locations (2)
PROVIDENCE MEDICAL FOUNDATION
1514 VALLEY VISTA DR
DIAMOND BAR, CA 917653929
9098601144
PROVIDENCE MEDICAL FOUNDATION
1950 SUNNY CREST DR, SUITE 2900
FULLERTON, CA 928353641
7149925350
Source: CMS National Downloadable File, September 2026.