| NPI | 1508813494 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JULIE "KRISTI" K BRAKER Authorized Official / Contract Mgmt 210-674-0257 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363AM0700X Physician Assistant, Medical | |
| 363LF0000X Nurse Practitioner, Family | |
| 363LP0200X Nurse Practitioner, Pediatrics | |
| Enumeration Date | 2006-05-27 |
| Last Update Date | 2024-10-29 |