Graduated: 2022
NPI: 1639852635
Practice Locations (2)
PROVIDENCE MEDICAL FOUNDATION
18310 US HWY 18, SUITE 200
APPLE VALLEY, CA 923072206
7609982312
DESERT VALLEY MEDICAL GROUP INC
16850 BEAR VALLEY RD
VICTORVILLE, CA 923955794
7602418000
Source: CMS National Downloadable File, September 2026.