| NPI | 1003168345 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARCIA ESPINOZA Dental Hygienist 951-638-3896 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities (Licence: CA HAP 428) |
| Additional Taxonomies | 302F00000X Exclusive Provider Organization (Licence: CA HAP 428) |
| 302R00000X Health Maintenance Organization (Licence: CA HAP 428) | |
| 305R00000X Preferred Provider Organization (Licence: CA HAP 428) | |
| 305S00000X Point of Service (Licence: CA HAP 428) | |
| Enumeration Date | 2012-10-10 |
| Last Update Date | 2012-10-10 |