| NPI | 1437495041 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA CRUZ Owner 208-346-2222 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: ID PA334) |
| Additional Taxonomies | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: ID M9188) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: ID M9188) | |
| 163W00000X Registered Nurse (Licence: ID N38708) | |
| Enumeration Date | 2012-12-31 |
| Last Update Date | 2013-04-17 |