Provider Demographics
NPI:1679336234
Name:CLINICA FAMILIAR VIDA Y SALUD
Entity type:Organization
Organization Name:CLINICA FAMILIAR VIDA Y SALUD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YENI
Authorized Official - Middle Name:
Authorized Official - Last Name:DELGADO CABRERA
Authorized Official - Suffix:
Authorized Official - Credentials:MEDICAL ASSISTANT
Authorized Official - Phone:770-696-9968
Mailing Address - Street 1:656 INDIAN TRAIL LILBURN RD NW STE 208
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-6872
Mailing Address - Country:US
Mailing Address - Phone:770-696-9968
Mailing Address - Fax:770-696-9859
Practice Address - Street 1:656 INDIAN TRAIL LILBURN RD NW STE 208
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-6872
Practice Address - Country:US
Practice Address - Phone:770-696-9968
Practice Address - Fax:770-696-9859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care