| NPI | 1104205400 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARIE WALTON Billing Manager 949-366-1053 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: PA OS017618) |
| Enumeration Date | 2015-05-20 |
| Last Update Date | 2025-03-05 |