| NPI | 1346067147 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LUISANA MEDINA Credentialing Coordinator 928-819-8834 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2024-09-23 |
| Last Update Date | 2024-09-23 |