| NPI | 1740754811 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PENNY CHAVEZ Executive Administrative Assistant 760-490-9982 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302R00000X Health Maintenance Organization |
| Enumeration Date | 2019-01-11 |
| Last Update Date | 2019-01-11 |