| NPI | 1801913355 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY ANN MARTINEZ Office Manager 909-861-1888 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: CA c40179) |
| Enumeration Date | 2007-03-22 |
| Last Update Date | 2020-08-22 |