| NPI | 1104183201 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL LANE LIPSKY Owner 805-371-6144 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: CA DC27804) |
| Enumeration Date | 2012-04-13 |
| Last Update Date | 2015-02-23 |