NPI | 1992181143 |
---|---|
Entity Type | Organization |
Authorized Contact | INGA SIMONIAN CEO 818-570-1636 |
Organization Subpart ? | No |
Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: CA PSY25302) |
Enumeration Date | 2015-08-10 |
Last Update Date | 2019-11-19 |