| NPI | 1649658824 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE LEE ALLEN Director Of Contract Compliance 559-251-4800 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center Multi-Specialty (Licence: CA G057966) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 251X00000X Supports Brokerage | |
| Enumeration Date | 2015-05-08 |
| Last Update Date | 2024-01-04 |