| NPI | 1215344783 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUAN ANTONIO T. TREJO CANCHOLA Managing Dentist 951-842-0803 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: CA 61049) |
| Enumeration Date | 2014-07-16 |
| Last Update Date | 2014-07-16 |