| NPI | 1356117816 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAWN ROMERO Practice Manager 629-220-0220 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 207QS0010X Family Medicine, Sports Medicine | |
| Enumeration Date | 2023-11-27 |
| Last Update Date | 2023-11-30 |