| NPI | 1639210610 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNY HEINO Directors Of Operations 858-625-2990 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 332900000X Non-Pharmacy Dispensing Site (Licence: OR MD13393) |
| Enumeration Date | 2007-02-10 |
| Last Update Date | 2023-01-26 |