Graduated: 2024
NPI: 1750827465
Practice Locations (4)
221 10TH ST, APT 4
HUNTINGTON BEACH, CA 926484800
501 N REO ST
Tampa, FL 336091012
501 N REO ST
TAMPA, FL 336091012
550 N REO ST, SUITE 150
TAMPA, FL 336091031
Source: CMS National Downloadable File, September 2026.