Graduated: 2009
NPI: 1770807778
Practice Locations (3)
7755 CTR AVE, SUITE 630
HUNTINGTON BEACH, CA 92647
393 E WALNUT ST FL, 3 PHR GROUP PROVIDER ENROLLMENT UNIT
Pasadena, CA 911880001
393 E WALNUT 3RD FL
PASEDENA, CA 911880001
Source: CMS National Downloadable File, September 2026.