| NPI | 1568785384 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRINA BALA Dir Clinical Services 855-297-8326 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2010-03-08 |
| Last Update Date | 2015-05-13 |