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General NPI Number Information
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NPI Number | 1164675914
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Entity Type | Organization
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Legal Business Name | METROLINA AIDS PROJECT, INC.
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Dates
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Enumeration Date | 10/24/2008
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Last Update Date | 06/15/2009
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Provider Practice Location Address
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Address Line | 5801 EXECUTIVE CENTER DR SUITE 114
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City | CHARLOTTE
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State | NC
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Zip | 28212-8861
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Country | US
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Telephone | 704-936-4460
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Fax | 704-936-4470
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Provider Business Mailing Address
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Address Line | PO BOX 32662
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City | CHARLOTTE
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State | NC
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Zip | 28232-2662
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Country | US
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Telephone | 704-333-1435
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Fax | 704-602-2440
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DR. JOSE R DIAZ
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Credential | M.D.
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Telephone | 704-333-1435
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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