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CLINICA NUEVA VIDA MEDICAL INC NPI 1164119970


NPI Information

NPI: 1164119970
Provider Name: CLINICA NUEVA VIDA MEDICAL INC
Classification: Clinic/Center - 261QP2300X
Entity Type: Organization

Specialization: Primary Care

CLIA Number: 05D2159984

Address:
10970 SHERMAN WAY STE 114
BURBANK, CA
ZIP 91505
Phone: (818) 847-1007
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CLINICA NUEVA VIDA MEDICAL INC is a primary care clinic center in Burbank, CA. CLINICA NUEVA VIDA MEDICAL INC NPI is 1164119970. The provider is registered as an organization entity type.

The provider's business location address is:

10970 SHERMAN WAY STE 114
BURBANK, CA
ZIP 91505-003
Phone: (818) 847-1007
Fax: (818) 847-1154

The provider's authorized official is Herman Fricke Carrillo .
The authorized official title is Md/ceo and has the following contact phone number (818) 847-1007.

The CLIA number assigned to this NPI record is 05D2159984 - practitioner other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 4/20/2023 and was last updated on 4/20/2023.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261QP2300XClinic/CenterPrimary CareYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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