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Individual

MY DIEP

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
DO

Contact information

Practice address
25865 BARTON RD STE 101 BLDG D, LOMA LINDA, CA 92354
(909) 558-2890
Mailing address
25865 BARTON RD STE 101 BLDG D, LOMA LINDA, CA 92354
(909) 558-2890

Taxonomy

Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
20A23759
CA

Other

Enumeration date
03/27/2021
Last updated
08/01/2025
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