2024-01204
Active
Yes
05/22/2024
11/12/2026
See: Actions-Adverse & Administrative Tab
Active Supervisees
| Name | Type | Status | Approved | Inactive |
| None Reported |
North Carolina Hospital Admitting Privileges
Out of State Active/Inactive Licenses
| State |
| Alaska |
| Arizona |
| Arkansas |
| California |
| Florida |
| Hawaii |
| Illinois |
| Massachusetts |
| Missouri |
| Montana |
| New Jersey |
| New Mexico |
| New York |
| Oregon |
| Pennsylvania |
| Rhode Island |
| Texas |
| Virginia |
| Washington |
| Wyoming |
Out of Country Active/Inactive Licenses
Address
Executive Medical, Inc.
1537 Grand Avenue, Ste A
San Marcos, CA 92078
760-290-3552
Information
Medical School
| School | Graduation |
| Wayne State University School of Medicine [Detroit, MI] | 1996 |
Post Graduate Training
"Last Year" does not necessarily mean that the licensee completed his/her training program. (In NC, a physician can be licensed without completing such a program.)
| Institution | Specialty | State, Country | Training Program | Last Year |
| Mayo Clinic Scottsdale Family Medicine Center | Family Medicine |
AZ, US
| Residency | 1999 |
Current Board Certification and Year of Certification/Recertification
Physicians should not list non-ABMS or non-AOA specialty boards unless the board meets the criteria set forth in the NC Medical Board’s Advertising and Publicity Position Statement.
| Primary/Subspecialty | Year |
| None Reported |
Area of Practice
| Area Of Practice | Primary |
| Family Medicine | Yes |
Current Membership in Medical Professional Organizations
Honors & Awards
| Honor/Award | Given By | Date |
| None Reported |
Public Service
| Name of Clinic | Service Description | Date |
| None Reported |
Current Academic Appointments
| Title | Institution | City, State, Country |
| None Reported |
Publications
Section 1: Adverse Actions
North Carolina Medical Board Public Actions
This section indicates whether the North Carolina Medical Board has taken adverse public action regarding the
licensee. Click on the link or links below to see an electronic copy of public documents associated with the
licensee.
Certain public documents, such as hearing transcripts, are listed but are not posted on the site. If the record
indicates a transcript is available, it may be obtained by contacting the Board.
NCMB public actions are posted on this site indefinitely.
| Date | Description | Link |
|
07/20/2026
| Public Letter of Concern |
View
|
Other Regulatory Board or Agency Public Actions
| Date | Name of Board/Agency | Action Taken | Link |
| None Reported |
Health Care Institution Suspensions and Revocations
| Date | Health Care Institution | Action Taken |
| None Reported |
Section 2: Administrative Actions
Actions listed in this section are considered non-disciplinary by the Board. In situations where
administrative actions are taken, the licensee may not have met certain statutory requirements or
may have failed to follow correct administrative procedures.
North Carolina Medical Board Reentry Agreement
| Date | Description | Link |
| None Reported |
North Carolina Special Purpose Licensing Agreement
| Date | Description | Link |
| None Reported |
Malpractice Information
The Board is currently reviewing the care that led to this payment.
| Incident Date | Payment Date | Area of Practice | City, State, Country | Response |
| None Reported |
Misdemeanor/DUI/DWI Conviction Information
| Conviction Date | Conviction | Jurisdiction | Sentence |
| None Reported |
Felony Conviction Information
| Conviction Date | Conviction | Jurisdiction | Sentence |
| None Reported |