| NPI | 1538604699 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DENNIS W. WALLSTROM Clinical Psychologist 909-603-9300 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY13058) |
| Enumeration Date | 2016-12-28 |
| Last Update Date | 2018-03-01 |