| NPI | 1548735202 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON P KELLOGG CEO 949-722-7118 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 2084N0400X Psychiatry & Neurology, Neurology | |
| Enumeration Date | 2018-10-09 |
| Last Update Date | 2019-08-08 |