Graduated: 2017
NPI: 1558057158
Practice Locations (3)
4980 NAVARRO ST
LOS ANGELES, CA 900322254
PHR GROUP PROVIDER ENROLLMENT UNIT
PASADENA, CA 911880001
PO BOX, SUITE 290609
NASHVILLE, TN 37229
Source: CMS National Downloadable File, September 2026.