| NPI | 1154671642 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DOUG CYR Billing Administrator 818-957-2192 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA G34138) |
| Enumeration Date | 2012-09-12 |
| Last Update Date | 2013-12-09 |