| NPI | 1871882712 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VANESSA CANEZ Office Manager 559-431-2397 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA A112259) |
| Additional Taxonomies | 332900000X Non-Pharmacy Dispensing Site |
| Enumeration Date | 2011-03-31 |
| Last Update Date | 2019-06-06 |