| NPI | 1104962448 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GERRY RODRIGUEZ Clinic Administrator 619-524-5204 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1100X Clinic/Center, MilitaryU.S. Coast Guard Outpatient |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2020-08-22 |