| NPI | 1902019151 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HELEN ROEHLK Adm. Assist. Credentialing 209-385-5434 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 040000300) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: CA 040000300) |
| 363AM0700X Physician Assistant, Medical (Licence: CA 040000300) | |
| 363LF0000X Nurse Practitioner, Family (Licence: CA 040000300) | |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2020-08-22 |