| NPI | 1023448511 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL VICIOSO Owner 562-473-4441 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: CA 22745) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA 22745) |
| Enumeration Date | 2013-11-19 |
| Last Update Date | 2019-12-24 |