| NPI | 1922546019 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VIPUL R DEV Owner 661-327-2101 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: CA A063639) |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty (Licence: CA A063639) |
| Enumeration Date | 2017-02-08 |
| Last Update Date | 2017-02-08 |