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General NPI Number Information
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NPI Number | 1265752588
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Entity Type | Organization
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Legal Business Name | LA CLINICA
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Dates
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Enumeration Date | 06/09/2010
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Last Update Date | 06/09/2010
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Provider Practice Location Address
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Address Line | 157 WILLIAM HILTON PKWY
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City | HILTON HEAD ISLAND
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State | SC
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Zip | 29926-5218
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Country | US
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Telephone | 843-338-1598
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Fax | 843-342-2710
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Provider Business Mailing Address
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Address Line | PO BOX 23253
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City | HILTON HEAD ISLAND
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State | SC
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Zip | 29925-3253
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Country | US
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Telephone | 843-338-1598
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Fax | 843-342-2710
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Authorized Official
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Title or Position | ADMINISTRATIVE ASSISTANT
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Name | MARIE E SATIZABAL
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Credential |
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Telephone | 843-338-1598
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | APN 1897
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License Number State | SC
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