| NPI | 1407021421 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LINDSAY MARTINEZ Office Manager 714-502-1144 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 305S00000X Point of Service (Licence: CA 00A325660) |
| Enumeration Date | 2008-04-30 |
| Last Update Date | 2020-03-26 |