| NPI | 1053430744 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RUSSELL BRUCE HUBBARD Owner 619-295-8005 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Additional Taxonomies | 2084P0802X Psychiatry & Neurology, Addiction Psychiatry |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2020-04-22 |