| NPI | 1619265311 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BROOKE E. WAGNER Owner/CEO 858-689-2027 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: CA 6687) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA 5056) |
| Enumeration Date | 2011-07-14 |
| Last Update Date | 2011-08-12 |