| NPI | 1972999613 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FRANK J FERNANDEZ COO 877-426-0930 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization |
| Additional Taxonomies | 302F00000X Exclusive Provider Organization |
| Enumeration Date | 2015-04-09 |
| Last Update Date | 2015-04-09 |