Graduated: 2024
NPI: 1215797154
Practice Locations (3)
393 E WALNUT ST FL, 3 PHR GROUP PROVIDER ENROLLMENT UNIT
Pasadena, CA 911880001
PHR GROUP PROVIDER ENROLLMENT UNIT
PASADENA, CA 911880001
393 E WALNUT 3RD FL
PASEDENA, CA 911880001
Source: CMS National Downloadable File, September 2026.