NPI | 1053062539 |
---|---|
Entity Type | Organization |
Authorized Contact | DANIEL DEFEO Physician Owner 551-815-1000 |
Organization Subpart ? | No |
Primary Taxonomy | 207Q00000X Family Medicine |
Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
Enumeration Date | 2022-01-16 |
Last Update Date | 2022-12-14 |