Registry details
Type
Individual
Primary specialty
Nurse Practitioner, Family
Enumerated
Sep 9, 2025
License(s)
95036557 (CA)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | 689 BLACKFORD CT | San Jose, CA 95117-1957 | |
| LOCATION | 689 BLACKFORD CT | San Jose, CA 95117-1957 | 408-981-7971 |
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