| NPI | 1053506287 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW LOREN WERNER Medical Director 760-396-9353 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: CA G79952) |
| Enumeration Date | 2007-09-11 |
| Last Update Date | 2010-02-22 |