| NPI | 1629306089 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELAINE ROSEN Director 818-528-5510 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: CA A50232) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA PSY14195) |
| 133VN1004X Dietitian, Registered, Nutrition, Pediatric (Licence: CA 898967) | |
| Enumeration Date | 2009-11-24 |
| Last Update Date | 2009-11-24 |