Graduated: 2016
NPI: 1437786464
Practice Locations (3)
222 S CENTRAL AVE, APT 112
LOS ANGELES, CA 900124233
393 E WALNUT ST FL, 3 PHR GROUP PROVIDER ENROLLMENT UNIT
Pasadena, CA 911880001
393 E WALNUT 3RD FL
PASEDENA, CA 911880001
Source: CMS National Downloadable File, September 2026.