Medical school: UNIVERSITY OF CALIFORNIA, DAVIS SCHOOL OF MEDICINE
Graduated: 2007
NPI: 1104017573
Practice Locations (2)
PROVIDENCE MEDICAL INSTITUTE
LAGUNA NIGUEL, CA 92677
PROVIDENCE MEDICAL INSTITUTE
1499 W 1ST ST
SAN PEDRO, CA 907323255
3108319482
Source: CMS National Downloadable File, September 2026.