Provider Demographics
NPI:1649540022
Name:CLINICA 'LOS ANGELES'
Entity type:Organization
Organization Name:CLINICA 'LOS ANGELES'
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JUANA
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-234-6948
Mailing Address - Street 1:5038 CORONADO PKWY
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34116-6950
Mailing Address - Country:US
Mailing Address - Phone:239-234-6948
Mailing Address - Fax:239-331-2362
Practice Address - Street 1:5038 CORONADO PKWY
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34116-6950
Practice Address - Country:US
Practice Address - Phone:239-234-6948
Practice Address - Fax:239-331-2362
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANGEL'S MEDICAL COMPANY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-01-03
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC-3923261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center