| NPI | 1679998694 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARTIN JAY PORCELLI CEO & President 909-620-1955 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: CA 20A4403) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: CA 20A4403) |
| Enumeration Date | 2014-02-27 |
| Last Update Date | 2014-03-11 |