| NPI | 1396114724 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LIBERTY MACIAS CEO 909-894-4260 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95002264) |
| Enumeration Date | 2015-09-16 |
| Last Update Date | 2015-09-16 |