| NPI | 1144691718 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMANDA MARIELLA MENIA President 818-930-1188 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: IL 70370328) |
| Additional Taxonomies | 261QC1500X Clinic/Center, Community Health (Licence: IL 70370328) |
| 261QH0100X Clinic/Center, Health Services (Licence: IL 70370328) | |
| 261QP1100X Clinic/Center, Podiatric (Licence: IL 70370328) | |
| 261QU0200X Clinic/Center, Urgent Care (Licence: IL 70370328) | |
| Enumeration Date | 2015-10-08 |
| Last Update Date | 2015-10-08 |