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General NPI Number Information
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NPI Number | 1215281217
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Entity Type | Organization
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Legal Business Name | MONROE COMMUNITY CLINIC
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Dates
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Enumeration Date | 10/30/2012
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Last Update Date | 10/30/2012
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Provider Practice Location Address
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Address Line | 4101 CENTRAL AVE
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City | CHARLOTTE
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State | NC
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Zip | 28205-5611
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Country | US
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Telephone | 704-563-5007
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Fax | 704-563-5070
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Provider Business Mailing Address
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Address Line | 4101 CENTRAL AVE
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City | CHARLOTTE
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State | NC
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Zip | 28205-5611
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Country | US
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Telephone | 704-563-5007
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Fax | 704-563-5070
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Authorized Official
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Title or Position | CLINIC MANAGER/OWNER
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Name | MRS. MARITZA RODRIGUEZ FORESTIER
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Credential |
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Telephone | 704-563-5007
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State | NC
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