Medical school: MAYO MEDICAL SCHOOL
Graduated: 1994
Offers telehealth
NPI: 1225120348
Practice Locations (1)
PROVIDENCE SAINT JOHNS MEDICAL FOUNDATION
2001 SANTA MONICA BLVD, SUITE 970W
SANTA MONICA, CA 904042199
3108297878
Source: CMS National Downloadable File, September 2026.