| NPI | 1477689024 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VALERIE LYNNE PAYNE Practice Administrator 951-682-3583 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: CA 22571) |
| Enumeration Date | 2007-02-26 |
| Last Update Date | 2020-08-22 |