Healthcare Provider Details

I. General information

NPI: 1043495450
Provider Name (Legal Business Name): LA CLINICA DEL PUEBLO, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2008
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2831 15TH ST NW
WASHINGTON DC
20009-4607
US

IV. Provider business mailing address

2831 15TH ST NW
WASHINGTON DC
20009-4607
US

V. Phone/Fax

Practice location:
  • Phone: 202-462-4788
  • Fax: 202-250-3290
Mailing address:
  • Phone: 202-462-4788
  • Fax: 202-250-3290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICAELA ACUNA
Title or Position: PATIENT REVENUE MANAGER
Credential:
Phone: 240-582-8828