Graduated: 1993
NPI: 1134104037
Practice Locations (3)
LAKE COUNTY TRIBAL HEALTH CONSORTIUM INC
925 BEVINS CT
LAKEPORT, CA 954539754
70726383821204
PROVIDENCE MEDICAL FOUNDATION
1165 MONTGOMERY DR
SANTA ROSA, CA 954054801
7075463210
SALEM HEALTH
890 OAK ST SE
SALEM, OR 973013905
5035615200
Source: CMS National Downloadable File, September 2026.