| NPI | 1104282888 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DORI LYNN WILSON Office Manager 949-521-6060 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CA 53145) |
| Enumeration Date | 2016-01-11 |
| Last Update Date | 2016-01-11 |