Registry details
Type
Individual
Primary specialty
Physician Assistant
Enumerated
Jul 12, 2022
License(s)
PA61707 (CA)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | 4140 W 190TH ST | Torrance, CA 90504-5513 | 310-423-1220 |
| LOCATION | 8635 W 3RD ST STE 590W | Los Angeles, CA 90048-6163 | 310-423-1220 |
Watch this provider
Get a webhook/email the day this provider is added to the OIG-LEIE exclusion list or appears in an FDA enforcement action.