| NPI | 1558754598 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANNON CLARK Owner 925-350-4742 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 551003) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: CA A103633) |
| Enumeration Date | 2015-03-16 |
| Last Update Date | 2015-03-16 |