| NPI | 1902348527 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AZILA S ORTIZ Administrator 858-366-8787 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: CA 374602950) |
| Enumeration Date | 2016-11-14 |
| Last Update Date | 2016-11-14 |