| NPI | 1912647694 |
|---|---|
| Other Name | FEE FOR SERVICE MIXED SPECIALTY GROUP |
| Entity Type | Organization |
| Authorized Contact | RUBY ZHANG Revenue Manager 707-565-7846 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2022-03-30 |
| Last Update Date | 2022-03-30 |