| NPI | 1104636208 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESUS MONTESANO Owner 645-229-1317 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2025-01-10 |
| Last Update Date | 2025-02-19 |