| NPI | 1639894637 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REBECA LAGUNA Credentialing Manager 442-600-5128 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty |
| Enumeration Date | 2022-10-11 |
| Last Update Date | 2022-10-11 |