| NPI | 1629538194 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GLENN PAUL MATNEY President 760-245-9363 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine |
| 2083A0300X Preventive Medicine, Addiction Medicine | |
| 2084A0401X Psychiatry & Neurology, Addiction Medicine | |
| 2084P0802X Psychiatry & Neurology, Addiction Psychiatry | |
| Enumeration Date | 2019-03-21 |
| Last Update Date | 2019-08-10 |