Registry details
Type
Individual
Primary specialty
Physician Assistant
Enumerated
Feb 26, 2026
License(s)
—
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | 5192 SKINNER ST | Irvine, CA 92604-2943 | |
| LOCATION | 590 N VERMONT AVE | Los Angeles, CA 90004-2115 | 323-284-7998 |
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