| NPI | 1629729355 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSE BENITO ALVAREZ DE LA LLANA President 909-961-7881 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2022-01-14 |
| Last Update Date | 2022-01-25 |