| NPI | 1194271189 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANA L TELAHUN Pharmacist 858-483-1489 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: CA 60385) |
| Enumeration Date | 2016-08-30 |
| Last Update Date | 2016-08-30 |