| NPI | 1053642009 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIEL JACOBSEN President 310-657-0366 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center Multi-Specialty (Licence: CA A85541) |
| Additional Taxonomies | 261QM1300X Clinic/Center Multi-Specialty (Licence: CA DC15646) |
| Enumeration Date | 2010-01-14 |
| Last Update Date | 2010-01-14 |