| NPI | 1770263659 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GUSTAVO MEDINA Managing Member 435-229-3234 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2023-07-24 |
| Last Update Date | 2023-07-24 |