| NPI | 1952364549 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES L BLOMMAERT Director 951-678-9152 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 18315) |
| Enumeration Date | 2006-04-06 |
| Last Update Date | 2020-08-22 |