Provider Demographics
NPI:1780199323
Name:LA FAMILIA HEALTH CLINIC, LLC
Entity Type:Organization
Organization Name:LA FAMILIA HEALTH CLINIC, LLC
Other - Org Name:LA FAMILIA MEDICAL CLINIC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:ROSARIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-237-8903
Mailing Address - Street 1:7625 SW 62ND CT STE 100
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34476-8322
Mailing Address - Country:US
Mailing Address - Phone:352-237-8903
Mailing Address - Fax:352-237-8962
Practice Address - Street 1:7625 SW 62ND CT STE 100
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34476
Practice Address - Country:US
Practice Address - Phone:352-237-8903
Practice Address - Fax:352-237-8962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-05
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1700055878OtherINDIVIDUAL NPI
FLACN560OtherLICENSE