Graduated: 1975
NPI: 1417951963
Practice Locations (2)
240 N VIRGIL AVE, SUITE 7
LOS ANGELES, CA 900045293
2133899100
SUPERCLINIC PROFESSIONALS MEDICAL CORP A CALIFORNIA CORPORATION
12134 VICTORY BLVD, SUITE C
NORTH HOLLYWOOD, CA 916063205
8187628702
Source: CMS National Downloadable File, September 2026.