| NPI | 1114072394 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATRINA AMBROSE Mental Health Clinican 559-907-4275 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: CA IMF-48553) |
| Enumeration Date | 2007-01-25 |
| Last Update Date | 2008-08-11 |