| NPI | 1912196171 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GRIGORY ROZENOVICH President 714-549-1409 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: CA 40115) |
| Enumeration Date | 2007-10-23 |
| Last Update Date | 2015-05-06 |