| NPI | 1982243812 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER LYNN CRUIKSHANK CEO 951-486-4458 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2019-12-23 |
| Last Update Date | 2020-03-16 |