| NPI | 1003270539 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHANIE DUQUE BARON Owner 909-294-7329 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CA PA 17201) |
| Enumeration Date | 2016-04-11 |
| Last Update Date | 2022-10-07 |