| NPI | 1104503168 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SYLVIA HASTANAN Vice President 310-795-8807 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care |
| Enumeration Date | 2023-06-30 |
| Last Update Date | 2023-10-31 |