Registry details
Type
Individual
Primary specialty
Nurse Practitioner
Enumerated
Aug 3, 2023
License(s)
95026344 (CA)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 445 W BEVERLY PL | Tracy, CA 95376-3010 | 209-855-1463 |
| MAILING | 445 W BEVERLY PL | Tracy, CA 95376-3010 | 209-855-1463 |
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.