| NPI | 1609582006 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THASANEE FONG Chief Executive Officer 909-718-2721 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2023-01-30 |
| Last Update Date | 2023-03-01 |