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ActiveCalifornia 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
- Fictitious Name Permit Physicians & Surgeons
More from the license record
- License type code
- 8008
Contact
18035 Brookhurst St # 1100
Fountain Valley, CA 92708-6738
Fountain Valley, CA 92708-6738
Orange County