| NPI | 1831355544 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACEY MAX NIJST Personal Service Coordinator 714-226-9888 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: CA I9910608) |
| Enumeration Date | 2008-08-01 |
| Last Update Date | 2008-08-01 |