| NPI | 1063999639 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW S DAVIS Owner 626-318-5854 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: WA MD60849018) |
| Additional Taxonomies | 2084P0804X Psychiatry & Neurology Child & Adolescent Psychiatry (Licence: WA MD60849018) |
| Enumeration Date | 2018-07-25 |
| Last Update Date | 2020-04-08 |