| NPI | 1689863995 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK W BENNALLACK Co Owner 714-289-4693 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213E00000X Podiatrist |
| Additional Taxonomies | 111N00000X Chiropractor |
| 207LP2900X Anesthesiology, Pain Medicine | |
| 207R00000X Internal Medicine | |
| 207XX0004X Orthopaedic Surgery, Foot and Ankle Surgery | |
| 208100000X Physical Medicine & Rehabilitation | |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery | |
| 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) | |
| Enumeration Date | 2007-10-23 |
| Last Update Date | 2008-06-24 |