| NPI | 1770381436 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMIKA HENRY Owner 323-496-0134 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 208D00000X General Practice |
| Enumeration Date | 2025-03-06 |
| Last Update Date | 2025-03-06 |