| NPI | 1396548236 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PETE CARRASCO CEO 909-944-0486 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208600000X Surgery |
| Additional Taxonomies | 2086S0129X |
| 213E00000X Podiatrist | |
| Enumeration Date | 2025-03-27 |
| Last Update Date | 2025-03-27 |