| NPI | 1013732940 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DERRICK WAYNE SMITH CEO 818-515-7991 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2024-11-15 |
| Last Update Date | 2024-11-15 |