| NPI | 1871952267 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW JOSEPH BERRIA President 208-740-4518 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363LP0200X Nurse Practitioner, Pediatrics | |
| Enumeration Date | 2016-02-15 |
| Last Update Date | 2024-02-01 |