Registry details
Type
Individual
Primary specialty
Nurse Practitioner, Family
Enumerated
Nov 2, 2024
License(s)
95030683 (CA)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | 631 S BROOKHURST ST | Anaheim, CA 92804-3510 | 714-991-5700 |
| LOCATION | 631 S BROOKHURST ST | Anaheim, CA 92804-3510 | 714-991-5700 |
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.