| NPI | 1497780480 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THERESA GONZALES Director Of Billing 619-881-4516 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QC1500X Clinic/Center, Community Health |
| Additional Taxonomies | 332900000X Non-Pharmacy Dispensing Site (Licence: CA 0507268) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2022-07-21 |