| NPI | 1558925016 |
|---|---|
| Doing Business As | LAKE ELSINORE CLINICA MEDICA FAMILIAR |
| Entity Type | Organization |
| Authorized Contact | MIKIA BRAYTON WALLIS CEO 760-767-6641 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2019-04-30 |
| Last Update Date | 2019-04-30 |