NPI | 1154114361 |
---|---|
Doing Business As | OLD PUEBLO SPECIALTY GROUP |
Entity Type | Organization |
Authorized Contact | BRYAN EDWARD CASTLE Owner 520-603-8043 |
Organization Subpart ? | No |
Primary Taxonomy | 207RG0300X Internal Medicine, Geriatric Medicine |
Enumeration Date | 2025-05-28 |
Last Update Date | 2025-06-01 |