| NPI | 1265087985 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGELICA M NIETO Owner 760-771-8887 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery |
| Additional Taxonomies | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2019-08-08 |
| Last Update Date | 2021-02-15 |