| NPI | 1699123737 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ILDAR FAZULYANOV Chief Operating Officer 310-384-0970 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2016-05-31 |
| Last Update Date | 2021-03-08 |