| NPI | 1770355257 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW LEE BLOOM Medical Director 805-351-0745 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation |
| Additional Taxonomies | 111NR0400X Chiropractor Rehabilitation |
| 261QP3300X Clinic/Center Pain | |
| Enumeration Date | 2023-10-26 |
| Last Update Date | 2023-10-26 |