| NPI | 1770367468 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WENDY A BYRNE Payer Enrollment Manager 951-503-1430 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 207R00000X Internal Medicine | |
| Enumeration Date | 2023-08-23 |
| Last Update Date | 2025-05-14 |