| NPI | 1407852015 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LYNETTE HENRIOD Practice Manager/Administrator 805-495-6866 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 01263) |
| Enumeration Date | 2005-06-28 |
| Last Update Date | 2020-08-22 |