| NPI | 1215226642 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAURIE MANOS Credentialing 909-398-1550 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207N00000X Dermatology |
| Enumeration Date | 2011-04-06 |
| Last Update Date | 2011-04-06 |