Individual
BI MO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
757 WESTWOOD PLZ STE 3325, LOS ANGELES, CA 90095
(310) 267-8679
(310) 267-3899
Mailing address
5767 W CENTURY BLVD STE 400, LOS ANGELES, CA 90045-5631
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
A153181
CA
Other
Enumeration date
01/27/2015
Last updated
10/01/2019
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