| NPI | 1972973204 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEVE WILDISH Secretary 951-368-0428 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: CA G74798) |
| Enumeration Date | 2015-09-29 |
| Last Update Date | 2015-09-29 |