NPI | 1245924497 |
---|---|
Entity Type | Organization |
Authorized Contact | TAJ REYES Credentialing 907-891-7812 |
Organization Subpart ? | No |
Primary Taxonomy | 208D00000X General Practice |
Additional Taxonomies | 207R00000X Internal Medicine |
2084B0040X Psychiatry & Neurology, Behavioral Neurology & Neuropsychiatry | |
261QM1300X Clinic/Center, Multi-Specialty | |
Enumeration Date | 2023-06-08 |
Last Update Date | 2023-06-08 |