| NPI | 1164410494 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HAKAN ERIK WAHLSTROM Medical Director/President 951-275-9000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: CA A37140) |
| Enumeration Date | 2005-10-11 |
| Last Update Date | 2020-08-22 |