| NPI | 1093355349 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RONALD KOOCH Managing Director 951-345-3053 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine |
| Enumeration Date | 2020-01-14 |
| Last Update Date | 2020-01-14 |