| NPI | 1366783391 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARLOS A PALACIOS Provider 626-771-7194 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: CA D33059) |
| Enumeration Date | 2013-03-15 |
| Last Update Date | 2013-03-15 |