| NPI | 1881639946 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANNMARIE CARLISLE Practice Administrator 858-455-5524 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: CA A65396) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA G66287) |
| Enumeration Date | 2006-06-20 |
| Last Update Date | 2025-03-28 |