Individual
ADA NG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
26520 CACTUS AVE, MORENO VALLEY, CA 92555-3927
(858) 717-5963
Mailing address
14165 DARWIN DR APT 303, MORENO VALLEY, CA 92555-4044
(858) 717-5963
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
06/10/2025
Last updated
06/10/2025
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