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 |