| NPI | 1639491004 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARMAINE MARIE ALEXANDER Office Manager 818-757-7070 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: CA 54191) |
| Enumeration Date | 2010-02-25 |
| Last Update Date | 2010-02-25 |