| NPI | 1417757725 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DWAYNE THOMPSON Business Administrator 714-278-7622 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2025-03-17 |
| Last Update Date | 2025-03-17 |