| NPI | 1962493288 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL TWEEDELL Deputy Director 951-358-5222 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A72474) |
| Additional Taxonomies | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) (Licence: CA 250000680) |
| Enumeration Date | 2005-11-04 |
| Last Update Date | 2023-03-07 |