| NPI | 1639457872 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DELIA Z REYES Np 951-780-6142 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: CA 392583) |
| Additional Taxonomies | 275N00000X Medicare Defined Swing Bed Unit (Licence: CA 392583) |
| Enumeration Date | 2011-07-21 |
| Last Update Date | 2011-07-21 |