| NPI | 1255735908 |
|---|---|
| Former Legal Business Name | SAME |
| Entity Type | Organization |
| Authorized Contact | DAVID GYEPES Principal 310-957-2710 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization |
| Enumeration Date | 2014-10-09 |
| Last Update Date | 2022-07-21 |