| NPI | 1073053997 |
|---|---|
| Doing Business As | NONE |
| Entity Type | Organization |
| Authorized Contact | ABDIQADIR SALAD HASSAN Director 562-606-8284 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 305R00000X Preferred Provider Organization |
| Enumeration Date | 2017-02-24 |
| Last Update Date | 2017-02-24 |