| NPI | 1063411460 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TANIE DONALDSON Office Manager 909-882-2266 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA 28926) |
| Additional Taxonomies | 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery (Licence: CA G55682) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: CA A84930) | |
| 225100000X Physical Therapist (Licence: CA PT 10673) | |
| 363AS0400X Physician Assistant, Surgical (Licence: CA PA20947) | |
| Enumeration Date | 2005-07-18 |
| Last Update Date | 2018-04-23 |