Provider Demographics
NPI:1922131374
Name:LA CLINICA DEL NINO PC
Entity Type:Organization
Organization Name:LA CLINICA DEL NINO PC
Other - Org Name:INTERNATIONAL PEDIATRICS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SUZANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-263-9101
Mailing Address - Street 1:3780 HOLCOMB BRIDGE RD STE C
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CORNERS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-4877
Mailing Address - Country:US
Mailing Address - Phone:770-263-9101
Mailing Address - Fax:770-263-9102
Practice Address - Street 1:3780 HOLCOMB BRIDGE RD
Practice Address - Street 2:STE C
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30092-2701
Practice Address - Country:US
Practice Address - Phone:770-263-9101
Practice Address - Fax:770-263-9102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty