| NPI | 1912176728 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GEORGE OLIVIER DETARNOWSKY Owner 949-574-5026 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: CA G41113) |
| Additional Taxonomies | 305R00000X Preferred Provider Organization (Licence: CA G41113) |
| Enumeration Date | 2008-02-26 |
| Last Update Date | 2008-10-21 |