| NPI | 1205576345 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY MARTIN Owner 626-223-5071 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0000X |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Enumeration Date | 2022-03-29 |
| Last Update Date | 2022-03-29 |