Registry details
Type
Individual
Primary specialty
Physician Assistant
Enumerated
Oct 23, 2013
License(s)
PA22747 (CA)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 944 BLUE HERON | Seal Beach, CA 90740-5612 | 510-333-7835 |
| MAILING | 944 BLUE HERON | Seal Beach, CA 90740-5612 | 510-333-7835 |
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.