Registry details
Type
Individual
Primary specialty
Physician Assistant
Enumerated
Dec 3, 2014
License(s)
52120 (CA)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 2158 DERRINGER LN | Diamond Bar, CA 91765-3333 | 909-861-3358 |
| MAILING | 2158 DERRINGER LN | Diamond Bar, CA 91765-3333 |
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.