| NPI | 1851007173 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHANIE CLARK-POVEDA Owner 909-274-9143 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 208D00000X General Practice |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2023-01-30 |
| Last Update Date | 2023-01-30 |