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General NPI Number Information
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NPI Number | 1922131374
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Entity Type | Organization
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Legal Business Name | LA CLINICA DEL NINO PC
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Dates
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Enumeration Date | 03/14/2007
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Last Update Date | 02/19/2018
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Provider Practice Location Address
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Address Line | 3780 HOLCOMB BRIDGE RD STE C
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City | NORCROSS
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State | GA
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Zip | 30092-2701
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Country | US
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Telephone | 770-263-9101
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Fax | 770-263-9102
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Provider Business Mailing Address
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Address Line | 3780 HOLCOMB BRIDGE RD STE C
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City | PEACHTREE CORNERS
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State | GA
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Zip | 30092-4877
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Country | US
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Telephone | 770-263-9101
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Fax | 770-263-9102
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Authorized Official
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Title or Position | BUSINESS ADMINISTRATOR
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Name | SUZANA MONTANA
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Credential | M.D.
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Telephone | 770-263-9101
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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