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General NPI Number Information
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NPI Number | 1043495450
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Entity Type | Organization
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Legal Business Name | LA CLINICA DEL PUEBLO, INC
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Dates
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Enumeration Date | 01/03/2008
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Last Update Date | 10/09/2024
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Provider Practice Location Address
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Address Line | 2831 15TH ST NW
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City | WASHINGTON
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State | DC
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Zip | 20009-4607
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Country | US
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Telephone | 202-462-4788
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Fax | 202-250-3290
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Provider Business Mailing Address
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Address Line | 2831 15TH ST NW
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City | WASHINGTON
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State | DC
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Zip | 20009-4607
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Country | US
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Telephone | 202-462-4788
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Fax | 202-250-3290
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Authorized Official
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Title or Position | PATIENT REVENUE MANAGER
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Name | MICAELA ACUNA
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Credential |
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Telephone | 240-582-8828
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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