| NPI | 1912197294 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GINA WALLACE Billing Agent 209-571-8330 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: CA 39491) |
| Enumeration Date | 2007-08-01 |
| Last Update Date | 2007-08-01 |