| NPI | 1154646982 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAYE A DONNELLY Credentialing COO Rdinator 707-968-2809 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RC0000X Internal Medicine Cardiovascular Disease (Licence: CA C32535) |
| Additional Taxonomies | 208800000X Urology (Licence: CA A106559) |
| Enumeration Date | 2010-04-05 |
| Last Update Date | 2010-04-05 |