| NPI | 1700553930 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | OTHONIELLA ORTEGA General Practitioner 829-889-9858 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 261QV0200X Clinic/Center, VA |
| Enumeration Date | 2021-08-25 |
| Last Update Date | 2021-08-27 |