| NPI | 1972518603 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RAYMOND JOLTN MIKELIONIS Md President Of Corporation 916-786-0222 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA G21006) |
| Enumeration Date | 2006-07-30 |
| Last Update Date | 2008-05-23 |