| NPI | 1316834724 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSE BANUELOS Np 424-888-0608 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2025-06-19 |
| Last Update Date | 2025-06-23 |