| NPI | 1629406103 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LORNA STEPHANIE TRUJILLO Mhc1 209-468-4240 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: CA asw 28264) |
| Enumeration Date | 2013-10-21 |
| Last Update Date | 2013-10-21 |