| NPI | 1114311800 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERIK MATTHEW MATSON President 619-920-4696 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: CA 62434) |
| Enumeration Date | 2015-03-20 |
| Last Update Date | 2015-03-20 |