| NPI | 1376390062 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LACIE BAUER Manager 619-710-9543 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 103T00000X Psychologist |
| 122300000X Dentist | |
| 207W00000X Ophthalmology | |
| 2084P0800X Psychiatry & Neurology, Psychiatry | |
| 231H00000X Audiologist | |
| Enumeration Date | 2024-05-01 |
| Last Update Date | 2024-05-01 |