NPI | 1659912723 |
---|---|
Doing Business As | MIND BLOOM LA JOLLA |
Entity Type | Organization |
Authorized Contact | KRISTIN MARIE LULICH CEO 253-218-8755 |
Organization Subpart ? | No |
Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
Additional Taxonomies | 363L00000X Nurse Practitioner |
Enumeration Date | 2019-09-30 |
Last Update Date | 2019-09-30 |