Provider Demographics
NPI:1437563616
Name:SAINT ANTOINE DE PADOUE ATLANTIC HEALTH CLINIC
Entity Type:Organization
Organization Name:SAINT ANTOINE DE PADOUE ATLANTIC HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP
Authorized Official - Prefix:MS
Authorized Official - First Name:BERGERETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:SAINT-VICTOR
Authorized Official - Suffix:
Authorized Official - Credentials:FNP BC
Authorized Official - Phone:310-847-0875
Mailing Address - Street 1:226 W 10TH ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90813-4218
Mailing Address - Country:US
Mailing Address - Phone:310-847-9875
Mailing Address - Fax:
Practice Address - Street 1:226 W 10TH ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-4218
Practice Address - Country:US
Practice Address - Phone:310-847-9875
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-16
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CABU21412090261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care