| NPI | 1174930572 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID FUKUDA Medical Director 909-528-6858 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA NP13242) |
| Enumeration Date | 2014-07-17 |
| Last Update Date | 2014-07-17 |