| NPI | 1629164322 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBYN BURNS Chief 619-528-4082 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: CA CCS00105F) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2020-08-22 |