Graduated: 1988
NPI: 1629288329
Practice Locations (2)
1100 E BROADWAY, SUITE 205
GLENDALE, CA 912052490
8184535192
SOUTHERN CALIFORNIA PERMANENTE MEDICAL GROUP
13652 CANTARA ST
PANORAMA CITY, CA 914025423
8183752000
Source: CMS National Downloadable File, September 2026.