| NPI | 1558673210 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JODI FREY President 818-700-5494 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: CA MFC27173) |
| Enumeration Date | 2010-07-10 |
| Last Update Date | 2010-07-10 |