Provider Demographics
NPI:1689017170
Name:CLINICA MEDICA PRENATAL INC
Entity Type:Organization
Organization Name:CLINICA MEDICA PRENATAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:ESMERARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUZ MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:FNP, NP-C
Authorized Official - Phone:678-521-1624
Mailing Address - Street 1:4300 BUFORD HWY NE
Mailing Address - Street 2:SUITE: 216
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30345-1003
Mailing Address - Country:US
Mailing Address - Phone:404-636-8282
Mailing Address - Fax:404-636-8286
Practice Address - Street 1:4300 BUFORD HWY NE
Practice Address - Street 2:SUITE: 216
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30345-1003
Practice Address - Country:US
Practice Address - Phone:404-636-8282
Practice Address - Fax:404-636-8286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-15
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA00227204261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care