| NPI | 1609425255 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACEY M HEIN Provider 408-358-1841 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2019-09-06 |
| Last Update Date | 2019-09-06 |