| NPI | 1376669481 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LINDA YVONNE FULLERTON Administrator 530-221-1565 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: CA BUSS LIC# 23151) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2021-06-16 |