| NPI | 1821117284 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW JOSEPH FAVA Doctor 209-769-9554 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: CA 47392) |
| Enumeration Date | 2007-03-28 |
| Last Update Date | 2012-04-05 |