| NPI | 1114419538 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA PEREZ Owner 682-334-7426 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health |
| 363LG0600X Nurse Practitioner, Gerontology | |
| Enumeration Date | 2018-06-01 |
| Last Update Date | 2018-06-19 |