NPI | 1629541685 |
---|---|
Entity Type | Organization |
Authorized Contact | EURAL E. GORDON Owner 661-321-9138 |
Organization Subpart ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine |
Additional Taxonomies | 207QA0000X Family Medicine, Adolescent Medicine |
207QA0505X Family Medicine, Adult Medicine | |
Enumeration Date | 2019-01-02 |
Last Update Date | 2019-02-05 |