| NPI | 1730298407 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REUBEN DEMISA NUGAS Office Manager 562-421-2188 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: CA A34342) |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2020-08-22 |