| NPI | 1033154778 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID FLETCHER VARGAS Doctor 760-242-2361 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: CA g175010) |
| Enumeration Date | 2006-06-17 |
| Last Update Date | 2020-08-22 |