| NPI | 1679182216 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DMITRIY GRINBERG CEO 424-251-8388 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 122300000X Dentist |
| 261QC1500X Clinic/Center, Community Health | |
| 261QF0050X Clinic/Center, Family Planning, Non-Surgical | |
| 261QH0100X Clinic/Center, Health Services | |
| 261QP2000X Clinic/Center, Physical Therapy | |
| 261QP2300X Clinic/Center, Primary Care | |
| 261QX0100X Clinic/Center, Occupational Medicine | |
| Enumeration Date | 2020-07-29 |
| Last Update Date | 2020-07-29 |