Medical school: UN OF CALIFORNIA, IRVINE, COLLEGE OF MEDICINE
Graduated: 1999
NPI: 1730102104
Practice Locations (2)
PROVIDENCE MEDICAL INSTITUTE
GLENDALE, CA 91202
PROVIDENCE MEDICAL INSTITUTE
1010 N SEPULVEDA BLVD
MANHATTAN BEACH, CA 902665929
3103766262
Source: CMS National Downloadable File, September 2026.