Organization Name: | SOUTHEASTERN CT PRIMARY CARE, LLC |
NPI Number: | 1134591696 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | ROSALINDA G GAONA (PHYSICIAN) |
Mailing Address: | 10 Liberty Way Unit B10 Niantic |
State: | CT US |
Postal Code: | 063571033 |
Phone Number: | 8606918084 |
Fax Number: | 8606911195 |
NPI Enumeration Date: | 10/23/2015 |
NPI Last Update Date: | 02/05/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2300X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Primary Care |
Taxonomy Definition: |