| NPI | 1376106849 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH E ALLEN Owner/Provider 619-225-1212 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine |
| Enumeration Date | 2019-04-19 |
| Last Update Date | 2022-06-29 |