| NPI | 1003664319 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK SUTTON Owner/Provider 760-256-1004 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2024-05-10 |
| Last Update Date | 2024-07-16 |