| NPI | 1629342993 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FAITH A ROEDIGER DE BONILLA Credentialing/Contracting Specialis 916-226-3736 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 174400000X Specialist |
| 261QI0500X Clinic/Center, Infusion Therapy | |
| Enumeration Date | 2012-03-02 |
| Last Update Date | 2017-12-12 |