| NPI | 1104244029 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDUARDO ANGUIZOLA Medical Director 877-882-9832 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: CA A28494) |
| Additional Taxonomies | 111NX0800X Chiropractor Orthopedic (Licence: CA 26628) |
| 174400000X Specialist (Licence: CA PSY6247) | |
| Enumeration Date | 2014-03-29 |
| Last Update Date | 2014-03-29 |