| NPI | 1255961355 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JULIE DOMINGUEZ President 833-644-8244 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RN0300X Internal Medicine, Nephrology |
| Additional Taxonomies | 208D00000X General Practice |
| 363LF0000X Nurse Practitioner, Family | |
| Enumeration Date | 2020-01-17 |
| Last Update Date | 2025-01-27 |