Provider Demographics
NPI:1780254201
Name:CENTRO PRENATAL DE NORCROSS CORP.
Entity type:Organization
Organization Name:CENTRO PRENATAL DE NORCROSS CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSALBA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-492-8477
Mailing Address - Street 1:5195 JIMMY CARTER BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30093-1649
Mailing Address - Country:US
Mailing Address - Phone:470-514-5818
Mailing Address - Fax:
Practice Address - Street 1:5195 JIMMY CARTER BLVD STE 100
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-1649
Practice Address - Country:US
Practice Address - Phone:470-514-5818
Practice Address - Fax:770-734-9793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-28
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty