| NPI | 1104217801 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PEGGY M. BAKER Billing/Credentialing 619-697-0470 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: CA IMF84197) |
| Enumeration Date | 2015-02-17 |
| Last Update Date | 2015-02-17 |