| NPI | 1457034795 |
|---|---|
| Former Legal Business Name | N/A |
| Entity Type | Organization |
| Authorized Contact | ARMI REGALA SAN AGUSTIN Managing Member 424-205-9207 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Enumeration Date | 2023-08-11 |
| Last Update Date | 2023-08-11 |