| NPI | 1730136573 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN BLASINGAME Dispensary Manager 858-888-7700 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: CA FNP38252) |
| Enumeration Date | 2006-05-27 |
| Last Update Date | 2021-09-20 |