| NPI | 1831309848 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIE RUTH DEAN Lvn 209-688-7720 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: CA vn128313) |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2020-08-22 |