| NPI | 1083365084 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANTONIO GAMBOA President 337-408-0797 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| Enumeration Date | 2022-01-12 |
| Last Update Date | 2023-05-12 |