| NPI | 1548977242 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERIC EFUETNGU CFO 951-318-5396 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health |
| Additional Taxonomies | 2085R0204X Radiology Vascular & Interventional Radiology |
| Enumeration Date | 2022-11-01 |
| Last Update Date | 2023-09-07 |