| NPI | 1295435493 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGELA MCMAHON Program Director 619-871-7345 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X |
| Additional Taxonomies | 261QE0800X |
| 261QM2500X Clinic/Center, Medical Specialty | |
| Enumeration Date | 2023-03-06 |
| Last Update Date | 2023-03-06 |