| NPI | 1972740835 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AYYAMPALAYAM RAJU MOHAN Administrator 909-622-6050 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CA A37819) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: CA A37819) |
| Enumeration Date | 2009-01-14 |
| Last Update Date | 2009-01-14 |