| NPI | 1912367897 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY ANDREW GORDON Ms Psychology 619-865-1016 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2016-03-04 |
| Last Update Date | 2016-03-04 |