Graduated: 2019
NPI: 1093330599
Practice Locations (2)
REVIVE PATHWAY
1240 BROADWAY
EL CAJON, CA 920214994
6198411310
PUYALLUP TRIBAL OPIOID CLINIC INC
503 E 26TH ST, CEDAR WELLNESS CLINIC
TACOMA, WA 984211343
2538817001
Source: CMS National Downloadable File, September 2026.