| NPI | 1619687175 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARYROSE TAMORO LAZATIN Office Manager 331-871-6674 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RG0300X Internal Medicine, Geriatric Medicine |
| Enumeration Date | 2022-11-24 |
| Last Update Date | 2025-01-09 |