| NPI | 1821287988 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHELLY D. COFRESI Office Manager 916-391-1161 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: CA 40536) |
| Enumeration Date | 2007-10-15 |
| Last Update Date | 2007-10-15 |