| NPI | 1760803209 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | YESENIA RODRIGUEZ Clinical Director 909-621-0713 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: CA 1-11-8970) |
| Additional Taxonomies | 251S00000X (Licence: CA 1-11-9303) |
| Enumeration Date | 2013-12-31 |
| Last Update Date | 2015-10-07 |