| NPI | 1093138604 |
|---|---|
| Other Name | GROUP NPI |
| Entity Type | Organization |
| Authorized Contact | JULEEN MARIE STIMSON Administrator 805-925-1009 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center Health Service |
| Enumeration Date | 2014-02-03 |
| Last Update Date | 2022-03-11 |