| NPI | 1972096295 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PERCIVAL JOHN BALDRIAS Nurse Practitioner/CFO 909-920-3171 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA 20A12214) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA NP16510) |
| Enumeration Date | 2018-06-11 |
| Last Update Date | 2018-06-11 |