Provider Demographics
NPI:1114141660
Name:CLINICA SANTA FE
Entity Type:Organization
Organization Name:CLINICA SANTA FE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LOZANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-495-7942
Mailing Address - Street 1:3750 VENTURE DR
Mailing Address - Street 2:SUITE 130
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-1808
Mailing Address - Country:US
Mailing Address - Phone:770-495-7942
Mailing Address - Fax:770-495-7943
Practice Address - Street 1:3750 VENTURE DR
Practice Address - Street 2:SUITE 130
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-1808
Practice Address - Country:US
Practice Address - Phone:770-495-7942
Practice Address - Fax:770-495-7943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2007000070261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty