| NPI | 1417009861 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARLENE MAVILA THOMPSON Doctor 760-740-2595 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: CA 50382) |
| Enumeration Date | 2007-01-17 |
| Last Update Date | 2017-10-16 |