| NPI | 1043538010 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAURIE MANOS Credentialing 909-398-1550 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207RE0101X Internal Medicine Endocrinology, Diabetes & Metabolism |
| 363LF0000X Nurse Practitioner Family | |
| Enumeration Date | 2010-05-14 |
| Last Update Date | 2011-04-06 |