| NPI | 1750835013 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LIBERTY MACIAS Partner 909-894-4260 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty (Licence: CA 56486) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95002264) |
| Enumeration Date | 2016-08-04 |
| Last Update Date | 2016-08-04 |