| NPI | 1720126964 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRUCE ORIEL Owner 253-876-0760 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics |
| Enumeration Date | 2007-02-01 |
| Last Update Date | 2020-08-22 |