Provider Demographics
NPI:1336739432
Name:LA CLINICA DEL PUEBLO CORP
Entity Type:Organization
Organization Name:LA CLINICA DEL PUEBLO CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MASIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MOREIRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-515-3156
Mailing Address - Street 1:10300 SUNSET DR STE 380
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-3020
Mailing Address - Country:US
Mailing Address - Phone:305-418-0580
Mailing Address - Fax:305-402-0941
Practice Address - Street 1:10300 SUNSET DR STE 380
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3020
Practice Address - Country:US
Practice Address - Phone:305-541-5245
Practice Address - Fax:305-541-5246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-22
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
No2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric PulmonologyGroup - Multi-Specialty