| NPI | 1053047142 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARYROSE TAMORO LAZATIN Office Manager 331-871-6674 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RG0300X Internal Medicine, Geriatric Medicine |
| Enumeration Date | 2022-07-29 |
| Last Update Date | 2022-07-29 |