| NPI | 1801281639 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JORGE REYES Owner 213-458-1459 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: CA LCS 27150) |
| Additional Taxonomies | 302F00000X Exclusive Provider Organization (Licence: CA LCS 27150) |
| Enumeration Date | 2015-03-30 |
| Last Update Date | 2016-02-10 |