| NPI | 1568150662 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAURIE BOOKER Credentialing Manager 951-681-8693 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty |
| Enumeration Date | 2023-04-26 |
| Last Update Date | 2023-06-30 |