| NPI | 1861755654 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON DIAMOND Sole Owner 310-859-9816 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207YX0905X Otolaryngology, Otolaryngology/Facial Plastic Surgery (Licence: CA A78700) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: CA A78700) |
| 207X00000X Orthopaedic Surgery (Licence: CA A78700) | |
| Enumeration Date | 2012-06-18 |
| Last Update Date | 2012-06-18 |