Individual
LAC VU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5555 RESERVOIR DR STE 205, SAN DIEGO, CA 92120-5148
(619) 286-5858
(619) 286-1474
Mailing address
5555 RESERVOIR DR STE 205, SAN DIEGO, CA 92120-5148
(619) 286-5858
(619) 286-1474
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
A54417
CA
Other
Enumeration date
11/17/2006
Last updated
07/08/2007
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