| NPI | 1952809592 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERNEST VASTI Owner 209-463-0891 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: CA G54133) |
| Enumeration Date | 2018-01-29 |
| Last Update Date | 2020-10-22 |