Registry details
Type
Individual
Primary specialty
Physician Assistant
Enumerated
Dec 2, 2025
License(s)
—
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | PO BOX 4056 | Irvine, CA 92616-4056 | 949-812-2673 |
| MAILING | PO BOX 4056 | Irvine, CA 92616-4056 | 949-812-2673 |
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