| NPI | 1053176677 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | IRMA J DOMINGUEZ Office Manager 480-507-2199 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2024-02-14 |
| Last Update Date | 2024-02-14 |