Graduated: 2006
NPI: 1134463532
Practice Locations (2)
SOUTHERN CALIFORNIA PERMANENTE MEDICAL GROUP
9961 SIERRA AVE
FONTANA, CA 923356720
9094275000
SOUTHERN CALIFORNIA PERMANENTE MEDICAL GROUP
1717 E DATE PL
SAN BERNARDINO, CA 924044428
8887500036
Source: CMS National Downloadable File, September 2026.