| NPI | 1285800045 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMY DEHAVEN Credentialing Specialist 210-615-9990 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX M8786) |
| Enumeration Date | 2008-05-01 |
| Last Update Date | 2008-05-01 |