NPI | 1457565590 |
---|---|
Entity Type | Organization |
Authorized Contact | HELEN ROEHLK Admin. Assist. Credentialing 209-385-5434 |
Organization Subpart ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 550000303) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CA 550000303) |
363LF0000X Nurse Practitioner, Family (Licence: CA 550000303) | |
Enumeration Date | 2007-05-09 |
Last Update Date | 2020-08-22 |