| NPI | 1457201147 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMAURI SANTIAGO ROSALES PONCE DE LEON Owner 702-331-2094 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2026-02-02 |
| Last Update Date | 2026-03-01 |