| NPI | 1245770155 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DOROTHY MARION Office Manager 650-771-2814 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: CA G059072) |
| Enumeration Date | 2017-02-27 |
| Last Update Date | 2017-02-27 |