| 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 |