| NPI | 1396156030 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDWYN W. ORTIZ-NANCE Clinical Psychologist Administrator 559-252-6353 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: CA PSB94020449) |
| Additional Taxonomies | 302F00000X Exclusive Provider Organization (Licence: CA PSB94020449) |
| Enumeration Date | 2014-05-15 |
| Last Update Date | 2014-05-15 |