| NPI | 1801217435 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEANNA LOVE Manager 424-213-4290 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086S0127X Surgery, Trauma Surgery (Licence: CA A62260) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA A62260) |
| 2086S0102X Surgery, Surgical Critical Care (Licence: CA A62260) | |
| Enumeration Date | 2013-12-27 |
| Last Update Date | 2014-11-20 |