| NPI | 1215294830 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CRISTYANA SUGENG Office Manager 337-422-6240 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR1300X Clinic/Center, Rural Health (Licence: LA 2203782387) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: LA MD200292) |
| 363LF0000X Nurse Practitioner, Family (Licence: LA AP07807) | |
| Enumeration Date | 2012-04-19 |
| Last Update Date | 2023-03-07 |