| NPI | 1780062315 |
|---|---|
| Doing Business As | LIVING WATER MEDICAL CENTER |
| Entity Type | Organization |
| Authorized Contact | ISA JO Nurse Practitioner/Medical Director 209-241-4787 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: CO APN.0991226) |
| Enumeration Date | 2015-05-15 |
| Last Update Date | 2018-11-20 |