Graduated: 2012
NPI: 1972002236
Practice Locations (3)
607 S PROSPECT AVE, UNIT 307
REDONDO BEACH, CA 902774413
8588833277
PO BOX, SUITE 1290
VENICE, CA 90294
PO BOX, SUITE 1290
VENICE, CA 902941290
Source: CMS National Downloadable File, September 2026.