| NPI | 1629534045 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLIE A PONCE Chief Finance Officer 323-899-4988 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2019-02-11 |
| Last Update Date | 2019-02-11 |