Provider Demographics
NPI:1265752588
Name:LA CLINICA
Entity type:Organization
Organization Name:LA CLINICA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:E
Authorized Official - Last Name:SATIZABAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-338-1598
Mailing Address - Street 1:PO BOX 23253
Mailing Address - Street 2:
Mailing Address - City:HILTON HEAD ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29925-3253
Mailing Address - Country:US
Mailing Address - Phone:843-338-1598
Mailing Address - Fax:843-342-2710
Practice Address - Street 1:157 WILLIAM HILTON PKWY
Practice Address - Street 2:
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29926-5218
Practice Address - Country:US
Practice Address - Phone:843-338-1598
Practice Address - Fax:843-342-2710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-09
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPN 1897363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAPN 1897OtherMEDICAL LICENSE NUMBER