| NPI | 1528020112 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ADRIENNE M WALKE Contracts Administrator 909-398-1550 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207R00000X Internal Medicine |
| 208000000X Pediatrics | |
| 208600000X Surgery | |
| Enumeration Date | 2006-04-06 |
| Last Update Date | 2007-10-15 |