| NPI | 1962168104 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY LOU LOPEZ Director Of Billing 800-492-4227 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| Enumeration Date | 2021-11-11 |
| Last Update Date | 2025-04-09 |