| NPI | 1568024263 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MYRNA B FERNANDEZ Ur/Billing 951-813-1720 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084B0040X Psychiatry & Neurology, Behavioral Neurology & Neuropsychiatry |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral |
| 251S00000X Community/Behavioral Health | |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder | |
| Enumeration Date | 2019-07-02 |
| Last Update Date | 2020-06-09 |