| NPI | 1972716579 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HELEN ROEHLK Admin. Assist. Credentialing 209-385-5434 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 030000278) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA 030000278) |
| 207V00000X Obstetrics & Gynecology (Licence: CA 030000278) | |
| 208000000X Pediatrics (Licence: CA 030000278) | |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2020-08-22 |