| NPI | 1114103587 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALI HEIDARI Medical Director 909-982-1002 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: CA 05C0001814) |
| Additional Taxonomies | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Enumeration Date | 2008-01-16 |
| Last Update Date | 2024-01-29 |