| NPI | 1740507607 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALVARO BOLIVAR Owner 909-888-5552 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 208600000X Surgery |
| Enumeration Date | 2010-04-30 |
| Last Update Date | 2013-05-22 |