Medical school: UNIVERSITY OF TEXAS MEDICAL SCHOOL AT SAN ANTONIO
Graduated: 1976
NPI: 1861445645
Practice Locations (2)
PROVIDENCE MEDICAL INSTITUTE
20911 EARL ST, SUITE 440
TORRANCE, CA 905034355
3104198585
23600 TELO AVE, SUITE 250
TORRANCE, CA 905054037
3103758446
Source: CMS National Downloadable File, September 2026.