| NPI | 1558491043 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTINA CORNELL Credentialing Supervisor 408-579-6178 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) (Licence: CA FHC70262F) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 251X00000X Supports Brokerage | |
| Enumeration Date | 2007-03-06 |
| Last Update Date | 2023-05-04 |