| NPI | 1750506267 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HELEN ROEHLK Adm. Assist. Credentialing 209-385-5434 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CA 040000180) |
| Additional Taxonomies | 111NI0900X Chiropractor Internist (Licence: CA 040000180) |
| 1223G0001X Dentist General Practice (Licence: CA 040000180) | |
| 207Q00000X Family Medicine (Licence: CA 040000180) | |
| 208000000X Pediatrics (Licence: CA 040000180) | |
| 363AM0700X Physician Assistant Medical (Licence: CA 040000180) | |
| 363LF0000X Nurse Practitioner Family (Licence: CA 040000180) | |
| Enumeration Date | 2007-04-17 |
| Last Update Date | 2020-08-22 |