Organization Name: | CLINICA DE LA SALUD HISPANA LLC |
NPI Number: | 1093985343 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | EDGAR MIGUEL VELEZ (MANAGER) |
Mailing Address: | 969 Windy Hill Rd Se Suite E Smyrna |
State: | GA US |
Postal Code: | 300802003 |
Phone Number: | 6788880173 |
Fax Number: | 6788880177 |
NPI Enumeration Date: | 03/03/2008 |
NPI Last Update Date: | 03/04/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |