Graduated: 1986
NPI: 1366325839
Practice Locations (3)
4041 IBIS ST APT, SUITE 707
San Diego, CA 921036806
4041 IBIS ST, APT 707
SAN DIEGO, CA 921031833
4041 IBIS ST, APT 707
SAN DIEGO, CA 921036806
6193810694
Source: CMS National Downloadable File, September 2026.