NPI | 1639871627 |
---|---|
Entity Type | Organization |
Authorized Contact | DANIEL DISTEFANO Operations Manager 380-400-9215 |
Organization Subpart ? | No |
Primary Taxonomy | 207R00000X Internal Medicine |
Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty |
207RE0101X Internal Medicine, Endocrinology, Diabetes & Metabolism | |
208D00000X General Practice | |
Enumeration Date | 2023-03-21 |
Last Update Date | 2023-03-23 |