| NPI | 1881074300 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA ANN VANESSEN Insurance Administrator 805-955-9990 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA A134489) |
| Enumeration Date | 2015-06-01 |
| Last Update Date | 2015-08-31 |