| NPI | 1205681509 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICHOLE ROOST Otrl, Cht, Owner 760-712-9309 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Enumeration Date | 2024-04-19 |
| Last Update Date | 2024-04-19 |