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Organization

DIABETES RELIEF CENTER OF BRONX MSO LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DEANE' WALLACE (CREDENTIALING SPECIALIST)
(916) 571-9041
Entity
Organization

Contact information

Practice address
2825 3RD AVE STE 200, BRONX, NY 10455-4066
(916) 550-1050
(916) 550-1238
Mailing address
4441 AUBURN BLVD STE J, SACRAMENTO, CA 95841-4139
(916) 550-1050
(916) 550-1238

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary

Other

Enumeration date
09/05/2017
Last updated
09/05/2017
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