| NPI | 1063825289 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGELICA LEYLA SOTO Credentialing Specialist 855-434-7763 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A12647) |
| Enumeration Date | 2014-06-05 |
| Last Update Date | 2024-05-21 |