| NPI | 1104913565 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACY MUENZ Revenue Manager 760-726-0065 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) (Licence: CA 080000002) |
| Enumeration Date | 2006-10-06 |
| Last Update Date | 2020-08-22 |