| NPI | 1780401380 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LUISANA MEDINA Credentialing Coordinator 928-819-8834 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Enumeration Date | 2024-09-24 |
| Last Update Date | 2025-05-29 |