| NPI | 1316330202 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | OMAR STAPLES Owner/Physician Assistant 510-225-3977 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA 16192) |
| Enumeration Date | 2015-03-17 |
| Last Update Date | 2015-07-07 |