| NPI | 1528570678 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES KOSTOS Manager 818-823-4352 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site |
| Additional Taxonomies | 207KA0200X Allergy & Immunology Allergy (Licence: CA A82437) |
| Enumeration Date | 2017-10-30 |
| Last Update Date | 2017-10-30 |