| NPI | 1336839992 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VIRGINIA VILLANUEVA Compliance Officer/Secretary 951-236-9406 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QC1800X |
| Additional Taxonomies | 261QH0100X Clinic/Center, Health Services |
| Enumeration Date | 2023-05-08 |
| Last Update Date | 2023-05-08 |