| NPI | 1972772655 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BAMBI LYNN NICKELBERRY Director/Owner 310-673-3737 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: CA G466791) |
| Enumeration Date | 2008-02-26 |
| Last Update Date | 2022-06-21 |