| NPI | 1649752627 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DESERIE TSOSIE Credentialing Specialist 661-673-6726 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QU0200X Clinic/Center Urgent Care |
| Additional Taxonomies | 261QM0850X Clinic/Center Adult Mental Health |
| 261QM0855X Clinic/Center Adolescent and Children Mental Health | |
| Enumeration Date | 2018-09-05 |
| Last Update Date | 2018-09-05 |