| NPI | 1992751440 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BABAK ROSHDIEH Owner 951-734-6500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA A76333) |
| Additional Taxonomies | 332900000X Non-Pharmacy Dispensing Site |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2019-09-04 |