| NPI | 1861962185 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK KAPPICO Member 805-241-0742 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service |
| Additional Taxonomies | 251X00000X |
| Enumeration Date | 2018-11-29 |
| Last Update Date | 2018-11-29 |