| NPI | 1285409417 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | IVAN TARASENKO CEO 281-908-0686 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2023-11-17 |
| Last Update Date | 2025-11-18 |