| NPI | 1942690136 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAREN MADISON Credentialing Spec/Accounts Rec 818-848-3030 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: CA A112769) |
| Enumeration Date | 2015-01-27 |
| Last Update Date | 2023-07-13 |