| NPI | 1588952188 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTOPHER KOLSTAD Owner 858-859-2563 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center Ambulatory Surgical |
| Additional Taxonomies | 207YS0123X Otolaryngology Facial Plastic Surgery (Licence: CA A100294) |
| 207YX0905X Otolaryngology Otolaryngology/Facial Plastic Surgery | |
| Enumeration Date | 2011-07-16 |
| Last Update Date | 2025-08-21 |