| NPI | 1003336041 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NELSON BOND Director 657-251-0974 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A64392) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA CB267742) |
| 207Y00000X Otolaryngology (Licence: CA A64392) | |
| 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: CA E4237) | |
| Enumeration Date | 2017-06-21 |
| Last Update Date | 2024-07-12 |