| NPI | 1427123504 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MANUEL ERNESTO UMANZOR Pa 818-765-4917 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: CA 00a357301) |
| Enumeration Date | 2006-11-22 |
| Last Update Date | 2011-01-06 |