NPI | 1235343500 |
---|---|
Entity Type | Organization |
Authorized Contact | HELEN ROEHLK Admin. Assist. Credentialing 209-385-5434 |
Organization Subpart ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 040000180) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA 040000180) |
208000000X Pediatrics (Licence: CA 040000180) | |
Enumeration Date | 2007-05-09 |
Last Update Date | 2020-08-22 |