Graduated: 2000
NPI: 1407074511
Practice Locations (4)
1101 E BROADWAY
LONG BEACH, CA 908023543
PO BOX, SUITE 601422
SAN DEIGO, CA 921601422
402 W BROADWAY, SUITE 400
SAN DIEGO, CA 921013554
PO BOX, SUITE 601422
SAN DIEGO, CA 92160
Source: CMS National Downloadable File, September 2026.