| NPI | 1104542232 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RAYMOND JIMINEZ General Manager 833-208-7770 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| 363LF0000X Nurse Practitioner, Family | |
| 363LP0200X Nurse Practitioner, Pediatrics | |
| 363LP0222X Nurse Practitioner, Pediatrics, Critical Care | |
| 101YM0800X Counselor, Mental Health | |
| 104100000X Social Worker | |
| 106H00000X Marriage & Family Therapist | |
| 133V00000X Dietitian, Registered | |
| 183500000X Pharmacist | |
| 207R00000X Internal Medicine | |
| Enumeration Date | 2022-10-19 |
| Last Update Date | 2025-08-18 |