| NPI | 1801203310 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES HAEFNER Administration 949-600-9931 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: WA MD 60033065) |
| Enumeration Date | 2014-07-16 |
| Last Update Date | 2014-07-16 |