| NPI | 1578695607 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT ACHILLE DE STEFANO Owner CEO 818-222-7495 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: CA A21674) |
| Additional Taxonomies | 261QM2500X Clinic/Center, Medical Specialty (Licence: CA g58593) |
| Enumeration Date | 2007-03-12 |
| Last Update Date | 2010-10-07 |