NPI | 1083695290 |
---|---|
Entity Type | Organization |
Authorized Contact | MICHAEL TWEEDELL Deputy Director 951-358-5222 |
Organization Subpart ? | No |
Primary Taxonomy | 208000000X Pediatrics (Licence: CA A29358) |
Additional Taxonomies | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) (Licence: CA 208000000x) |
Enumeration Date | 2005-11-07 |
Last Update Date | 2023-03-07 |