| NPI | 1659301513 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DENISE DISMUKE-GIDEON Practice Administrator 510-428-3044 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: CA A77758) |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2020-08-22 |