| NPI | 1801040894 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARVIN J DERRICK Owner 661-664-9990 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: CA G47855) |
| Enumeration Date | 2008-11-04 |
| Last Update Date | 2008-11-04 |