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Individual

FEI NGO

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
1661 N RAYMOND AVE, 200, ANAHEIM, CA 92801-1120
(714) 656-7320
Mailing address
2708 WALNUT GROVE AVE, A, ROSEMEAD, CA 91770-3288
(626) 940-6915

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary

Other

Enumeration date
10/12/2015
Last updated
10/12/2015
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