| NPI | 1992853543 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MANJULA BOBBALA Physician 916-218-5618 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: A 87444) |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2020-08-22 |