| NPI | 1972248441 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACY GALLO Third Party Administrator 951-461-9573 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 207RC0200X Internal Medicine, Critical Care Medicine |
| 207RP1001X Internal Medicine, Pulmonary Disease | |
| Enumeration Date | 2022-04-29 |
| Last Update Date | 2022-04-29 |