| NPI | 1063536399 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REUVEN FERNANDEZ SISSON Owner 626-607-0333 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA A31954) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A85883) |
| Enumeration Date | 2007-03-19 |
| Last Update Date | 2008-01-04 |