| NPI | 1548393119 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELE R BROAD Owner 951-304-3180 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: CA 428809) |
| Additional Taxonomies | 363LW0102X Nurse Practitioner Women's Health (Licence: CA 428809) |
| Enumeration Date | 2007-03-13 |
| Last Update Date | 2015-12-15 |