| NPI | 1598013898 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER CHRISTINE LOPEZ Program Supervisor 619-952-6345 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: CA 0-12-4998) |
| Enumeration Date | 2012-08-17 |
| Last Update Date | 2012-08-17 |