| NPI | 1982824785 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GENEVIEVE MEDINA Credentialing Manager 209-384-6493 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 040000513) |
| 207R00000X Internal Medicine (Licence: CA 040000513) | |
| 363AM0700X Physician Assistant, Medical (Licence: CA 040000513) | |
| 363LF0000X Nurse Practitioner, Family (Licence: CA 040000513) | |
| Enumeration Date | 2007-04-26 |
| Last Update Date | 2021-01-08 |