| NPI | 1811384308 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMELIA FAJARDO Medical Director 888-587-9444 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: MI 4704277414) |
| Enumeration Date | 2015-04-22 |
| Last Update Date | 2015-04-22 |