| NPI | 1770725939 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JECONIAS LOPEZ DEMIAR Manager 909-222-4779 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: CA RN160039) |
| Enumeration Date | 2009-04-01 |
| Last Update Date | 2010-05-19 |