| NPI | 1447843651 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA CARRASCO Administrator 928-472-3906 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center Primary Care |
| Additional Taxonomies | 1223G0001X Dentist General Practice |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health | |
| Enumeration Date | 2021-02-18 |
| Last Update Date | 2025-08-26 |