| NPI | 1871940924 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NENA MACIEL Manager 760-981-7452 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: CA C54655) |
| Enumeration Date | 2016-05-18 |
| Last Update Date | 2022-07-21 |