| NPI | 1912516303 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHARY RODRIGUEZ Nurse Practitioner 208-504-5959 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 261QH0100X Clinic/Center, Health Services |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| 261QP2300X Clinic/Center, Primary Care | |
| Enumeration Date | 2020-07-30 |
| Last Update Date | 2020-07-30 |