NPI age
20 years
Enumerated 2005-11-18
Across 15966 active family medicine providers in Texas.
2 secondary locations on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 01 (CA) | 114404 | BOARD CERT # |
| 01 (CA) | 00A782130 | BLUE SHIELD OF CA PIN |
| 05 (CA) | 00A782130 |
Part of a multi-provider practice. 1 other active provider shares this practice address in NPPES.
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