| NPI | 1457734741 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES LEE WYNN Admin Aide 707-362-8769 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RN0300X Internal Medicine, Nephrology (Licence: CA 23313) |
| Additional Taxonomies | 261QH0100X Clinic/Center, Health Services |
| 261QP2300X Clinic/Center, Primary Care | |
| 332900000X Non-Pharmacy Dispensing Site | |
| Enumeration Date | 2015-07-04 |
| Last Update Date | 2024-04-30 |