Graduated: 2022
NPI: 1124777024
Practice Locations (3)
393 E WALNUT ST FL, 3 PHR GROUP PROVIDER ENROLLMENT UNIT
Pasadena, CA 911880001
393 E WALNUT ST 3RD FL
PASADENA, CA 911880001
PHR GROUP PROVIDER ENROLLMENT UNIT
PASADENA, CA 911880001
Source: CMS National Downloadable File, September 2026.