Registry details
Type
Individual
Primary specialty
Physician Assistant
Enumerated
Jan 6, 2010
License(s)
PA20745 (CA)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 661 W 1ST ST STE G | Tustin, CA 92780-2939 | 714-665-9890 |
| MAILING | 1331 W CENTRAL AVE APT 69 | Santa Ana, CA 92704-5778 | 562-760-0679 |
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