| NPI | 1043903875 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHARON FOUNTAIN Owner 949-696-6157 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2023-05-29 |
| Last Update Date | 2023-05-29 |