Individual
SAN M AYE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1717 W BEVERLY BLVD, STE A, MONTEBELLO, CA 90640-3971
(323) 728-7218
Mailing address
1717 W BEVERLY BLVD, STE A, MONTEBELLO, CA 90640-3971
(323) 728-7218
(323) 723-0057
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
A26642
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A266422
—
CA
Enumeration date
11/09/2006
Last updated
07/11/2008
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