| NPI | 1548569197 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DALE A PROKUPEK Owner 310-360-6807 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: CA G71035) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA G71035) |
| Enumeration Date | 2011-03-22 |
| Last Update Date | 2011-03-22 |