Medical school: NEW YORK MEDICAL COLLEGE
Graduated: 1980
NPI: 1568465334
Practice Locations (3)
PROVIDENCE MEDICAL INSTITUTE
LAGUNA NIGUEL, CA 92677
PROVIDENCE MEDICAL INSTITUTE
18133 VENTURA BLVD, SUITE 302
TARZANA, CA 913563645
8184667770
PROVIDENCE MEDICAL INSTITUTE
1220 LA VENTA DR, SUITE 202
WESTLAKE VILLAGE, CA 913613750
8054490066
Source: CMS National Downloadable File, September 2026.