| NPI | 1013366236 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACOB FLORES Owner 760-809-4045 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CA 20A13788) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: CA A60865) |
| Enumeration Date | 2016-06-08 |
| Last Update Date | 2017-05-12 |