Graduated: 2000
NPI: 1780975466
Practice Locations (2)
SOUTHERN CALIFORNIA PERMANENTE MEDICAL GROUP
9961 SIERRA AVE
FONTANA, CA 923356720
9094275000
SOUTHERN CALIFORNIA PERMANENTE MEDICAL GROUP
3330 CENTRE LAKE DR
ONTARIO, CA 917611211
9092714770
Source: CMS National Downloadable File, September 2026.