| NPI | 1154495737 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THERESA PASQUINELLI Provider Enrollment Coordinator 650-498-5710 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: CA G013460) |
| Enumeration Date | 2006-11-17 |
| Last Update Date | 2020-08-22 |