| NPI | 1891880787 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACY MUENZ Revenue Manager 760-726-0065 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: CA 080000002) |
| Additional Taxonomies | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) (Licence: CA 080000002) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2020-08-22 |