| NPI | 1417110834 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN D CARRICO Owner 310-540-9699 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111NR0400X |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 207R00000X Internal Medicine | |
| Enumeration Date | 2008-07-07 |
| Last Update Date | 2012-12-12 |