| NPI | 1932287158 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CAROLYN BOWE-MCLEOD Billing Administrator 760-433-7944 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OK 20A6431) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA 20A6431) |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2015-12-30 |