| NPI | 1346964806 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER KALISVAART Owner 562-277-0834 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2022-09-28 |
| Last Update Date | 2023-07-21 |