| NPI | 1386159945 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DOUGLAS PENNY Manager 949-481-6156 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: CA 370158AP) |
| Additional Taxonomies | 291U00000X Clinical Medical Laboratory |
| Enumeration Date | 2017-12-05 |
| Last Update Date | 2019-03-21 |