| NPI | 1457755845 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GABRIEL BONILLA Owner 928-600-6762 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation |
| 208VP0000X | |
| Enumeration Date | 2014-10-15 |
| Last Update Date | 2014-10-15 |