| NPI | 1629386594 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE MCCRACKEN Medical Assistant 805-496-2949 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: CA A41745) |
| Enumeration Date | 2010-09-14 |
| Last Update Date | 2010-09-14 |