| NPI | 1992796338 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL TWEEDELL Deputy Director 951-358-5222 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA11241) |
| Additional Taxonomies | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) (Licence: CA 250000537) |
| Enumeration Date | 2005-11-03 |
| Last Update Date | 2023-03-07 |