| NPI | 1003634353 |
|---|---|
| Doing Business As | CLUBRXPRO |
| Entity Type | Organization |
| Authorized Contact | RICHARD HEIMANN Medical Director 818-371-9466 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization |
| Enumeration Date | 2024-09-26 |
| Last Update Date | 2024-09-26 |