| NPI | 1255780748 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GRACIELA SEIJO Owner 760-277-0465 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: TX 26126) |
| Enumeration Date | 2016-06-06 |
| Last Update Date | 2016-06-06 |