| NPI | 1558767962 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MANNTEJ SRA Owner 623-815-8200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2014-11-12 |
| Last Update Date | 2014-11-12 |