| NPI | 1720417967 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FAITH A ROEDIGER DE BONILLA Credentialing/Contracting Specialis 916-226-3736 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX f7329) |
| 261QI0500X Clinic/Center, Infusion Therapy | |
| 364SW0102X Clinical Nurse Specialist, Women's Health (Licence: TX 533613) | |
| Enumeration Date | 2013-11-07 |
| Last Update Date | 2017-10-13 |