| NPI | 1205260817 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANA A GALVAN Credentialer 661-861-0011 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: CA G282420) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC30003) |
| 171100000X Acupuncturist (Licence: CA AC9103) | |
| 363A00000X Physician Assistant (Licence: CA PA15629) | |
| 363L00000X Nurse Practitioner (Licence: CA MC2665214) | |
| Enumeration Date | 2013-08-30 |
| Last Update Date | 2013-08-30 |