| NPI | 1164076683 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHERRY KOVACS Assistant/Provider Enrollment 949-552-5232 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Enumeration Date | 2019-08-01 |
| Last Update Date | 2019-08-10 |