| NPI | 1336939263 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VICRUMDEEP TUNG Owner 909-935-9345 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208600000X Surgery |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| Enumeration Date | 2025-05-12 |
| Last Update Date | 2025-05-12 |