| NPI | 1649943655 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN WOODHAM Owner 760-464-4944 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| Enumeration Date | 2021-07-26 |
| Last Update Date | 2021-11-17 |