| NPI | 1528348620 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GLEN FARKAS Medical Director 818-610-9360 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA G56249) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA PSY22296) |
| 111NN1001X Chiropractor, Nutrition (Licence: CA DC24805) | |
| 171100000X Acupuncturist (Licence: CA AC8403) | |
| 363A00000X Physician Assistant (Licence: CA PA17921) | |
| Enumeration Date | 2011-08-19 |
| Last Update Date | 2011-08-19 |