| NPI | 1356939680 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ITCHAQUEIRA BEATRIZ FONTANEZ VENDRELL Owner, Manager, Provider 863-258-7986 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302R00000X Health Maintenance Organization |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2021-01-03 |
| Last Update Date | 2021-01-03 |