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General NPI Number Information
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NPI Number | 1679336234
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Entity Type | Organization
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Legal Business Name | CLINICA FAMILIAR VIDA Y SALUD
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Dates
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Enumeration Date | 02/05/2024
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Last Update Date | 02/05/2024
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Provider Practice Location Address
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Address Line | 656 INDIAN TRAIL LILBURN RD NW STE 208
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City | LILBURN
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State | GA
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Zip | 30047-6872
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Country | US
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Telephone | 770-696-9968
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Fax | 770-696-9859
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Provider Business Mailing Address
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Address Line | 656 INDIAN TRAIL LILBURN RD NW STE 208
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City | LILBURN
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State | GA
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Zip | 30047-6872
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Country | US
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Telephone | 770-696-9968
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Fax | 770-696-9859
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Authorized Official
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Title or Position | OWNER
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Name | YENI DELGADO CABRERA
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Credential | MEDICAL ASSISTANT.
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Telephone | 770-696-9968
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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 |
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