| NPI | 1811153836 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIELLE EBRADO Cma/Medical Assistant 916-983-6400 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: CA G72120) |
| Enumeration Date | 2008-07-29 |
| Last Update Date | 2008-08-26 |