| NPI | 1215543178 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REBECCA JORDAN Provider 916-525-2021 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology |
| Additional Taxonomies | 207N00000X Dermatology |
| 207RA0401X Internal Medicine, Addiction Medicine | |
| 207RG0100X Internal Medicine, Gastroenterology | |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine | |
| Enumeration Date | 2020-09-16 |
| Last Update Date | 2020-09-16 |