| NPI | 1124618509 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ZAK CORONADO Administrator 623-521-9113 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2021-01-20 |
| Last Update Date | 2021-01-20 |