| NPI | 1154590057 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN DANIEL CHAVARIN Practice Administrator 949-548-6376 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty |
| Enumeration Date | 2008-02-25 |
| Last Update Date | 2008-02-25 |