| NPI | 1326676800 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN SALEM Owner 909-913-3333 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 207R00000X Internal Medicine |
| Enumeration Date | 2020-03-30 |
| Last Update Date | 2020-04-29 |