| NPI | 1003587148 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANNELISE DENNING Owner 707-732-4494 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 174400000X Specialist |
| Enumeration Date | 2021-09-27 |
| Last Update Date | 2025-01-08 |