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 |