| NPI | 1417848219 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSE ANTHONY BONILLA Executive Officer 714-420-9890 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| 208D00000X General Practice | |
| 2084P0800X Psychiatry & Neurology, Psychiatry | |
| Enumeration Date | 2025-07-10 |
| Last Update Date | 2025-12-08 |