| NPI | 1538612429 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONALD GODBOLD President 209-872-0480 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| Enumeration Date | 2016-07-27 |
| Last Update Date | 2016-07-27 |