| NPI | 1790098978 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIRK DE BRITO President 310-717-0069 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: CA A66604) |
| Additional Taxonomies | 305R00000X Preferred Provider Organization (Licence: CA PSY26446) |
| 302F00000X Exclusive Provider Organization (Licence: CA G64523) | |
| Enumeration Date | 2010-07-16 |
| Last Update Date | 2017-01-25 |