| NPI | 1164100657 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERIC YECIES Cco 800-852-1575 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 207K00000X Allergy & Immunology |
| 207Q00000X Family Medicine | |
| 207R00000X Internal Medicine | |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2023-07-06 |
| Last Update Date | 2024-05-28 |