| NPI | 1114120854 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CRYSTAL OLIVAS Contracts COO Rdinator 714-480-8666 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization |
| Enumeration Date | 2007-06-08 |
| Last Update Date | 2022-07-21 |