| NPI | 1922015072 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID ANTHONY MICHELIS Owner 949-645-4670 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2006-08-02 |
| Last Update Date | 2012-01-11 |