| NPI | 1417602764 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WALLACE DE ROTHSMAN CEO 650-379-9946 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 171000000X Military Health Care Provider | |
| 251T00000X Program of All-Inclusive Care for the Elderly (PACE) Provider Organization | |
| 302R00000X Health Maintenance Organization | |
| 305R00000X Preferred Provider Organization | |
| 3336M0003X Pharmacy Managed Care Organization Pharmacy | |
| Enumeration Date | 2022-02-15 |
| Last Update Date | 2022-02-15 |