| NPI | 1235855446 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARILIZ VEGA-ANDERSON Credentialing Manager 757-297-1346 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine |
| Enumeration Date | 2022-10-19 |
| Last Update Date | 2022-10-19 |