Provider Demographics
NPI:1013304997
Name:CLINICA NUEVA LLC
Entity Type:Organization
Organization Name:CLINICA NUEVA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:CUADRADO
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:470-375-8521
Mailing Address - Street 1:5944 BUFORD HWY
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30071-2444
Mailing Address - Country:US
Mailing Address - Phone:470-375-5821
Mailing Address - Fax:
Practice Address - Street 1:5944 BUFORD HWY
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30071-2444
Practice Address - Country:US
Practice Address - Phone:470-375-5821
Practice Address - Fax:470-375-5824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-19
Last Update Date:2015-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN220894363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty