| NPI | 1386529469 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NATHANIEL RANCE PENA Co Owner 818-927-9576 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2025-08-07 |
| Last Update Date | 2025-08-13 |