| NPI | 1629269873 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LARISA P GAVRILOVA-JORDAN Ref Fellow Physician 619-807-2953 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: NC 2006-00745) |
| Enumeration Date | 2007-08-05 |
| Last Update Date | 2007-08-05 |