Medical school: UNIVERSITY OF TEXAS MEDICAL SCHOOL AT SAN ANTONIO
Graduated: 2001
Offers telehealth
NPI: 1508971243
Practice Locations (1)
PROVIDENCE MEDICAL INSTITUTE
1010 N SEPULVEDA BLVD
MANHATTAN BEACH, CA 902665929
3103766262
Source: CMS National Downloadable File, September 2026.