| NPI | 1609762285 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROVIN SANTOS Principal Provider And Leader 224-425-1142 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2025-06-17 |
| Last Update Date | 2025-06-17 |