Provider Demographics
NPI:1396974853
Name:CENTRO DE SALUD FAMILIAR II , LLC
Entity type:Organization
Organization Name:CENTRO DE SALUD FAMILIAR II , LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ELISEO
Authorized Official - Middle Name:
Authorized Official - Last Name:VALLEJO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-361-0303
Mailing Address - Street 1:4921 JONESBORO RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:FOREST PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30297-4301
Mailing Address - Country:US
Mailing Address - Phone:404-361-0303
Mailing Address - Fax:404-361-0353
Practice Address - Street 1:4921 JONESBORO RD
Practice Address - Street 2:SUITE E
Practice Address - City:FOREST PARK
Practice Address - State:GA
Practice Address - Zip Code:30297-4301
Practice Address - Country:US
Practice Address - Phone:404-361-0303
Practice Address - Fax:404-361-0353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-06
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty