| NPI | 1114430568 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GENEVIEVE MEDINA Credentialing Manager 209-384-6493 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2017-11-08 |
| Last Update Date | 2017-11-08 |