| NPI | 1326415357 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHANIE BONILLA Counselor 310-549-2710 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: CA 6197-R) |
| Enumeration Date | 2015-08-25 |
| Last Update Date | 2015-08-25 |