| NPI | 1699034694 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SANDRA STEWART Program Director 760-240-4729 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center Health Service (Licence: CA NP6891) |
| Additional Taxonomies | 261Q00000X Clinic/Center (Licence: CA AJ1972579) |
| Enumeration Date | 2012-05-10 |
| Last Update Date | 2012-05-10 |