| NPI | 1770016172 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FAITH A DE BONILLA Credentialing Specialist 916-226-3736 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 174400000X Specialist |
| Enumeration Date | 2017-04-04 |
| Last Update Date | 2017-05-24 |