| NPI | 1841744562 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICHOLAS CARMEN BROCK President 805-637-8565 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: CA DC32547) |
| Enumeration Date | 2016-08-10 |
| Last Update Date | 2016-08-10 |