| NPI | 1306242359 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MAISIE MARIEL QUINTOS PASTRANO Owner/Manager 702-480-9006 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization |
| Enumeration Date | 2014-11-18 |
| Last Update Date | 2014-11-18 |