Individual
DI HE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1870 LUNDY AVE, SAN JOSE, CA 95131-1826
(415) 391-9686
Mailing address
10520 PINEVILLE AVE, CUPERTINO, CA 95014-4529
(650) 245-0433
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
61493
CA
Other
Enumeration date
08/26/2022
Last updated
10/01/2024
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