| NPI | 1043572076 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHYLE E BEAIRD CEO/Medical Director 949-855-8845 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA G81865) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: CA G81865) |
| 2083X0100X Preventive Medicine, Occupational Medicine (Licence: CA G81865) | |
| Enumeration Date | 2012-06-14 |
| Last Update Date | 2018-03-15 |