| NPI | 1730691171 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEANE WALLACE Credentialing Specialist 916-571-9041 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207RE0101X Internal Medicine, Endocrinology, Diabetes & Metabolism |
| Enumeration Date | 2017-10-25 |
| Last Update Date | 2017-10-25 |