| NPI | 1043629751 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALAN BENNETT COHEN Owner 949-733-1147 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: CA 101263817) |
| Additional Taxonomies | 305R00000X Preferred Provider Organization (Licence: CA 101263817) |
| 305S00000X Point of Service (Licence: CA 101263817) | |
| Enumeration Date | 2014-08-06 |
| Last Update Date | 2014-08-06 |