| NPI | 1992571418 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHIREEN BRIONES Provider Enrollment Manager 562-230-1461 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site |
| Enumeration Date | 2023-11-27 |
| Last Update Date | 2023-11-27 |