Individual
DEFEI MIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
15944 LOS SERRANOS COUNTRY CLUB DR STE 160, CHINO HILLS, CA 91709-3990
(909) 606-8893
Mailing address
20812 LYCOMING ST, WALNUT, CA 91789-3118
(626) 715-3870
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
95013234
CA
Other
Enumeration date
11/18/2019
Last updated
11/18/2019
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