Registry details
Type
Organization
Primary specialty
Internal Medicine
Enumerated
Sep 13, 2025
License(s)
—
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | 9624 SWAN LAKE DR | Granite Bay, CA 95746-6602 | 669-900-5721 |
| LOCATION | 9624 SWAN LAKE DR | Granite Bay, CA 95746-6602 | 669-900-5721 |
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.