| NPI | 1770020471 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRENT D DOUGLAS President 858-444-7578 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: CA A62940) |
| Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: CA A67126) |
| Enumeration Date | 2017-01-20 |
| Last Update Date | 2017-01-20 |