| NPI | 1518228980 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID RICHARD JENSEN Owner 661-273-2556 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: CA G044704) |
| Additional Taxonomies | 291U00000X Clinical Medical Laboratory (Licence: CA G044704) |
| 302F00000X Exclusive Provider Organization (Licence: CA G044704) | |
| 302R00000X Health Maintenance Organization (Licence: CA G044704) | |
| 305R00000X Preferred Provider Organization (Licence: CA G044704) | |
| 332BX2000X Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies (Licence: CA G044704) | |
| 3336M0002X Pharmacy, Mail Order Pharmacy (Licence: CA G044704) | |
| Enumeration Date | 2012-06-01 |
| Last Update Date | 2012-06-01 |