| NPI | 1306603329 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TYNA NGUYEN Office Manager 916-317-8796 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2024-03-05 |
| Last Update Date | 2024-03-05 |