| NPI | 1003141185 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FERNANDO G MIRANDA Medical Director 415-561-6755 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: CA A30680) |
| Enumeration Date | 2009-10-07 |
| Last Update Date | 2009-10-07 |