| NPI | 1003625179 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LIBERTY MACIAS CEO 909-370-4702 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) | |
| 363LF0000X Nurse Practitioner, Family | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| Enumeration Date | 2025-01-03 |
| Last Update Date | 2025-01-03 |