| NPI | 1447125893 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GWEN VANGELISTO Director Of Accounts Receivable 949-463-0893 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care |
| Enumeration Date | 2025-10-07 |
| Last Update Date | 2025-10-07 |