| NPI | 1801395173 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LELANIE FUENTES DENILA President 909-815-7340 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine |
| Enumeration Date | 2018-02-01 |
| Last Update Date | 2018-02-01 |