| NPI | 1154945913 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JODI BENNETT Administrator 951-423-2202 |
| Organization Subpart ? | No |
| Primary Taxonomy | 133N00000X Nutritionist |
| Additional Taxonomies | 207R00000X Internal Medicine |
| Enumeration Date | 2020-06-07 |
| Last Update Date | 2020-06-07 |