| NPI | 1124231865 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HELEN ROEHLK Adm. Assist. Credentialing 209-385-5434 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 030000519) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 030000519) |
| 207Q00000X Family Medicine (Licence: CA 030000519) | |
| 363AM0700X Physician Assistant, Medical (Licence: CA 030000519) | |
| 363LF0000X Nurse Practitioner, Family (Licence: CA 030000519) | |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2020-08-22 |