| NPI | 1376093013 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ADAMMA T EPOH Owner 310-400-9939 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302R00000X Health Maintenance Organization (Licence: CA 95002583) |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care (Licence: CA 95002583) |
| 305R00000X Preferred Provider Organization (Licence: CA 95002583) | |
| 311Z00000X Custodial Care Facility (Licence: CA 95002583) | |
| 314000000X Skilled Nursing Facility (Licence: CA 95002583) | |
| Enumeration Date | 2016-10-06 |
| Last Update Date | 2016-10-06 |