Graduated: 2020
NPI: 1922614056
Practice Locations (6)
393 E WALNUT ST
PASADEN, CA 911880001
PHR GROUP PROVIDER ENROLLMENT UNIT
PASADENA, CA 911880001
18321 CLARK ST
Tarzana, CA 913563501
19191 S VERMONT AVE, FL 7 BUSINESS OFFICE
TORRANCE, CA 905021018
14550 HAYNES ST
VAN NUYS, CA 914114116
2716 N TENAYA WAY FL, SUITE 6
LAS VEGAS, NV 891280424
Source: CMS National Downloadable File, September 2026.