| NPI | 1457628513 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMY VANBLARICOM Physician 949-706-0181 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: CA c52798) |
| Enumeration Date | 2011-11-17 |
| Last Update Date | 2011-11-17 |