| NPI | 1255865085 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW NICHOALS EGAN Owner 415-785-7131 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: CA 31550) |
| Enumeration Date | 2017-04-19 |
| Last Update Date | 2017-04-19 |