| NPI | 1962065904 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENI MAYORSKAYA Chief Executive Officer 415-801-0467 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization |
| Enumeration Date | 2019-04-16 |
| Last Update Date | 2019-04-16 |