| NPI | 1467697276 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD LICON CEO/President 949-243-4741 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA11666) |
| Enumeration Date | 2008-12-08 |
| Last Update Date | 2011-11-14 |