| NPI | 1124661251 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIELLE-MARVIS NTEZA FORTINGO Nurse Practitioner 469-634-6690 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302R00000X Health Maintenance Organization |
| Enumeration Date | 2019-10-22 |
| Last Update Date | 2019-12-12 |