| NPI | 1093171506 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EUSEBIO DAN LOPEZ Nurse Practitioner 909-629-7878 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95003565) |
| Additional Taxonomies | 261Q00000X Clinic/Center (Licence: CA 95003565) |
| 302F00000X Exclusive Provider Organization (Licence: CA 95003565) | |
| 302R00000X Health Maintenance Organization (Licence: CA 95003565) | |
| 305R00000X Preferred Provider Organization (Licence: CA 95003565) | |
| 305S00000X Point of Service (Licence: CA 95003565) | |
| 313M00000X Nursing Facility/Intermediate Care Facility (Licence: CA 95003565) | |
| 314000000X Skilled Nursing Facility (Licence: CA 95003565) | |
| Enumeration Date | 2016-01-13 |
| Last Update Date | 2016-01-13 |