| NPI | 1861700478 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PERCIVAL JOHN BALDRIAS Nurse Practitioner 909-203-3523 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 16510) |
| Enumeration Date | 2010-09-16 |
| Last Update Date | 2012-11-15 |