| NPI | 1598475329 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEVUNI HARRISON Billing And Credentialing Admin 909-710-2020 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery |
| Enumeration Date | 2022-12-02 |
| Last Update Date | 2022-12-02 |