| NPI | 1013353275 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERESA L GUTA Clinic Director 760-747-4737 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111NR0400X (Licence: CA DC20522) |
| Additional Taxonomies | 111NR0400X (Licence: CA DC21341) |
| Enumeration Date | 2013-05-15 |
| Last Update Date | 2013-05-15 |