Registry details
Type
Individual
Primary specialty
Family Medicine, Adult Medicine
Enumerated
Dec 27, 2006
License(s)
A77017 (CA)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | 30300 CAMINO CAPISTRANO | San Juan Capistrano, CA 92675-1304 | 949-240-2030 |
| LOCATION | 370 OCEAN AVE | Laguna Beach, CA 92651-2322 | 949-557-0610 |
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.