Registry details
Type
Individual
Primary specialty
Nurse Practitioner
Enumerated
Apr 2, 2020
License(s)
95017820 (CA)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | 1240 S SHERBOURNE DR PH 5 | Los Angeles, CA 90035-2369 | 404-543-3609 |
| LOCATION | 14445 OLIVE VIEW DR | Sylmar, CA 91342-1437 | 747-210-3000 |
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