| NPI | 1205853041 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TADDESE T DESTA Medical Director 619-266-3332 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: CA pending) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2020-08-22 |