| NPI | 1356710438 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAUL JOHN LICATA Owner 949-448-9728 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: CA A25662CA) |
| Enumeration Date | 2015-09-18 |
| Last Update Date | 2015-09-18 |