| NPI | 1053575548 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL A MENDEZ Practice Manager 805-604-4443 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086S0129X (Licence: CA A99886) |
| Additional Taxonomies | 2086S0129X (Licence: CA A79501) |
| Enumeration Date | 2008-07-14 |
| Last Update Date | 2008-07-14 |