| NPI | 1558196824 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REY JERICOH P MANALESE Pmhnp, Fnp 623-224-2403 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family |
| Enumeration Date | 2024-09-05 |
| Last Update Date | 2024-09-05 |