| NPI | 1851369284 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN MAZOROS Administrator 510-456-4650 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: CA 140000527) |
| Additional Taxonomies | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: CA 140000600) |
| Enumeration Date | 2006-03-10 |
| Last Update Date | 2017-11-02 |