| NPI | 1750718631 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIELLE KATHLEEN MOUL Owner/Physician 949-715-5676 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: CA a104213) |
| Enumeration Date | 2013-10-08 |
| Last Update Date | 2013-11-06 |