Provascularmd
ActiveCalifornia license 550983
License
- Licensed by
- Medical Board of California
- License number
- 550983
- Status
- Active (Current)
- First issued
- March 3, 2020
- Expires
- March 31, 2028
- Entity type
- Organization
Classifications
- Fictitious Name Permit Physicians & Surgeons
More from the license record
- License type code
- 8008
Contact
16133 Kamana Rd
Apple Valley, CA 92307-1377
Apple Valley, CA 92307-1377
San Bernardino County