Individual
ELI IPP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
21840 NORMANDIE AVE, STE. 700, TORRANCE, CA 90502-2047
(310) 222-5101
(310) 320-5463
Mailing address
21840 NORMANDIE AVE, STE. 700, TORRANCE, CA 90502-2047
(310) 222-5101
(310) 320-5463
Taxonomy
Speciality
Code
Description
License number
State
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
C41730
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00C417300
—
CA
01
—
CH1382
RAILROAD MEDICARE
CA
01
—
DA6447
RAILROAD MEDICARE
CA
01
—
M050376
GROUP
CA
01
—
W1494D
GROUP
CO
Enumeration date
04/07/2006
Last updated
07/29/2009
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