Graduated: 2022
NPI: 1962126342
Practice Locations (4)
1980 KETTNER BLVD, APT 432
SAN DIEGO, CA 921012252
1980 KETTNER BLVD, APT 432
SAN DIEGO, CA 921012264
44478 KINGSTON DR
TEMECULA, CA 925925621
PO BOX, SUITE 290609
NASHVILLE, TN 37229
Source: CMS National Downloadable File, September 2026.