NPI | 1912575093 |
---|---|
Entity Type | Organization |
Authorized Contact | MALAR KUPPAN Np/Manager And Member 623-261-5258 |
Organization Subpart ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
Additional Taxonomies | 101YM0800X Counselor, Mental Health |
261QM0801X | |
261QM0850X Clinic/Center, Adult Mental Health | |
261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
261QP2300X Clinic/Center, Primary Care | |
363LA2100X Nurse Practitioner, Acute Care | |
Enumeration Date | 2021-06-15 |
Last Update Date | 2024-04-29 |