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California license 551709

License

Licensed by
Medical Board of California
License number
551709
Status
Active (Current)
First issued
October 19, 2020
Expired
October 31, 2026
Entity type
Organization

Classifications

More from the license record

License type code
8008

Contact

18035 Brookhurst St # 1100
Fountain Valley, CA 92708-6738
Orange County