| NPI | 1609965748 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REYNALDO O GOMEZ Physician 760-416-3390 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: CA A51395) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA G86746) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2020-08-22 |