| NPI | 1366680639 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SARAH NINNESS-SEVERIOS Physical Therapist 310-913-3969 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: CA 35342) |
| Additional Taxonomies | 302R00000X Health Maintenance Organization (Licence: CA 35342) |
| Enumeration Date | 2009-01-26 |
| Last Update Date | 2009-01-26 |