NPI 1417338690
This NPI was deactivated on October 1, 2026. The record is kept for reference and should not be used for billing or referrals.
NPI 1417338690 is listed in the national NPI registry. Works from 2 locations.
Practice location Incomplete address
No coordinates on file. Search this address in Google Maps
Additional practice locations (1)
- 12301 Wilshire Blvd., Los Angeles, CA 90025-9002 — (818) 943-5497
Specialties & licences
Record details
| NPI number | 1417338690 |
|---|---|
| Entity type | Individual (Type 1) |
| NPI enumerated | — |
| Last updated in NPPES | — |