| NPI | 1285963769 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD ALAN PORTILLO President 209-578-4885 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: CA 7865T) |
| Enumeration Date | 2009-12-13 |
| Last Update Date | 2012-09-18 |