Facts
- Status
- A
- Type
- Organization
- Enumeration date
- 2006-11-30
- Last updated
- 2026-07-29
Licenses
- License CA
- 550000678
Location
- Practice location
- 1113 HIGHWAY 49
- City
- SAN ANDREAS CA
- Postal code
- 95249
- Phone
- 209-755-1400
Organization contact
- Name
- MARIELA CONTRERAS
- Title
- Executive Director
- Phone
- 2097546262
Medicare
- PECOS
- A PECOS enrollment row matches this NPI.
LEIE
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Removal request
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