| NPI | 1942428461 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANTAE D. DAVIES President 805-577-7977 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: CA G28898) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA G28898) |
| Enumeration Date | 2007-04-22 |
| Last Update Date | 2017-11-09 |