| NPI | 1881019123 |
|---|---|
| Other Name | INDIVIDUAL |
| Entity Type | Organization |
| Authorized Contact | MABEL VASQUEZ Intern 626-428-6916 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2014-02-24 |
| Last Update Date | 2014-02-24 |