Provider Demographics
NPI:1194176834
Name:LA CLINICA DEL PUEBLO, INC
Entity type:Organization
Organization Name:LA CLINICA DEL PUEBLO, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PATIENT REVENUE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICAELA
Authorized Official - Middle Name:
Authorized Official - Last Name:ACUNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-582-8828
Mailing Address - Street 1:2970 BELCREST CENTER DR
Mailing Address - Street 2:SUITE 301
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-1987
Mailing Address - Country:US
Mailing Address - Phone:202-448-2845
Mailing Address - Fax:202-332-0085
Practice Address - Street 1:2970 BELCREST CENTER DR
Practice Address - Street 2:SUITE 301
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20782-1987
Practice Address - Country:US
Practice Address - Phone:202-448-2845
Practice Address - Fax:202-332-0085
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LA CLINICA DEL PUEBLO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-06-23
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC650001047261Q00000X
261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center