Provider Demographics
NPI:1629623343
Name:LA CLINICA, LLC
Entity Type:Organization
Organization Name:LA CLINICA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:E
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:678-869-5000
Mailing Address - Street 1:10479 ALPHARETTA ST STE 18
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-3764
Mailing Address - Country:US
Mailing Address - Phone:678-869-5000
Mailing Address - Fax:678-869-5014
Practice Address - Street 1:10479 ALPHARETTA ST STE 18
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-3764
Practice Address - Country:US
Practice Address - Phone:678-869-5000
Practice Address - Fax:678-869-5014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-08
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care