| NPI | 1891209359 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD O CAMACHO Owner 209-227-7806 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A93056) |
| Additional Taxonomies | 261QP2300X Clinic/Center Primary Care (Licence: CA A93056) |
| Enumeration Date | 2017-11-20 |
| Last Update Date | 2018-10-28 |