| NPI | 1982736351 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LESLIE MARIE RADENTZ Executive Officer 951-600-3946 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA C504460) |
| Enumeration Date | 2007-03-12 |
| Last Update Date | 2020-08-22 |