| NPI | 1942457288 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CECILIA DE LEON Owner 907-563-5002 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty (Licence: AK 918565) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AK 918565) |
| 363AM0700X Physician Assistant, Medical (Licence: AK 918565) | |
| Enumeration Date | 2008-08-19 |
| Last Update Date | 2012-07-24 |