| NPI | 1790493104 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LIDICE GISEL CARRILLO CABRERA President 954-589-2539 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care |
| Enumeration Date | 2022-11-14 |
| Last Update Date | 2022-11-14 |