| NPI | 1851623029 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WALTER RAY O'BRIEN Owner 310-477-7276 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine Sports Medicine (Licence: CA G63193) |
| Enumeration Date | 2010-02-12 |
| Last Update Date | 2023-03-07 |