| NPI | 1245963297 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDREA WARNKE Billing Manager 805-210-2219 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086S0129X |
| Additional Taxonomies | 305R00000X Preferred Provider Organization |
| Enumeration Date | 2022-07-07 |
| Last Update Date | 2022-09-23 |