| NPI | 1356561682 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SANDIE FOWLER Credentialing Specialist 707-556-5991 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA 019731) |
| Enumeration Date | 2007-04-27 |
| Last Update Date | 2012-04-12 |