| NPI | 1841774759 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SALLY A DEWALD Director Of Business Svcs 707-525-6485 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086S0122X Surgery Plastic and Reconstructive Surgery |
| Additional Taxonomies | 208600000X Surgery |
| Enumeration Date | 2018-09-18 |
| Last Update Date | 2020-12-14 |