| NPI | 1679988950 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARTHA VALENCIA Credentialing Specialist 539-900-7627 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2014-06-25 |
| Last Update Date | 2024-06-25 |