| NPI | 1538871678 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARLON SALAMAT CFO 747-600-2058 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2022-12-20 |
| Last Update Date | 2022-12-20 |