| NPI | 1134278971 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACY GRECO Sr. Enrollment Manager 223-341-8516 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 2086X0206X Surgery, Surgical Oncology |
| 207Q00000X Family Medicine | |
| 208000000X Pediatrics | |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2025-11-21 |