| NPI | 1164253563 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTINA CORNELL Credentialing Supervisor 408-579-6178 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2024-08-08 |
| Last Update Date | 2024-08-08 |