| NPI | 1154547065 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CYNTHIA PRENDIZ Program Coordinator 909-984-7384 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA 240000826) |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2015-10-22 |