| NPI | 1780206813 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY NEIL ROBERTS President 909-223-0338 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center Multi-Specialty |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery |
| 207Y00000X Otolaryngology | |
| Enumeration Date | 2020-05-12 |
| Last Update Date | 2020-12-10 |