| NPI | 1417161621 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SALVADOR E LASALA President 909-886-3100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TP2701X Psychologist, Group Psychotherapy (Licence: CA A52616) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: CA A52616) |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: CA A52616) | |
| Enumeration Date | 2007-05-09 |
| Last Update Date | 2020-08-22 |