| NPI | 1700175189 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CAROL CASTILLO Administrator 424-249-3783 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center Ambulatory Surgical (Licence: CA A84519) |
| Additional Taxonomies | 173000000X Legal Medicine (Licence: CA A84519) |
| Enumeration Date | 2011-04-06 |
| Last Update Date | 2011-04-06 |