Graduated: 2023
NPI: 1205415254
Practice Locations (2)
18427 VINCENNES ST, SUITE 133
NORTHRIDGE, CA 913252173
7472309245
SOUTHERN CALIFORNIA MEDICAL CENTER INC
14550 HAYNES ST
VAN NUYS, CA 914111613
8186506700
Source: CMS National Downloadable File, September 2026.