Graduated: 2021
NPI: 1992381347
Practice Locations (3)
5767 W CENTURY BLVD, SUITE 400
LOS ANGELES, CA 900455631
393 E WALNUT ST FL, 3 PHR GROUP PROVIDER ENROLLMENT UNIT
Pasadena, CA 911880001
393 E WALNUT 3RD FL
PASEDENA, CA 911880001
Source: CMS National Downloadable File, September 2026.