| NPI | 1356220677 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ORLAND MATA CRUZ Manager 869-840-0639 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2025-08-29 |
| Last Update Date | 2025-08-29 |