| NPI | 1003920935 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTINA ANN WHITMORE Insurance Biller 661-322-8687 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: CA A043422) |
| Enumeration Date | 2006-08-18 |
| Last Update Date | 2020-08-22 |