Graduated: 1996
NPI: 1164457420
Practice Locations (2)
DHHS PHS IHS PHOENIX AREA
401 E PICACHO RD
WINTERHAVEN, CA 922839605
DHHS PHS IHS PHOENIX AREA
401 PICACHO RD
WINTERHAVEN, CA 922839605
7605724137
Source: CMS National Downloadable File, September 2026.