| NPI | 1336121888 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIRTRINA JONES Credentialing Supervisor 909-946-4222 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry |
| Enumeration Date | 2005-11-18 |
| Last Update Date | 2024-02-09 |