# LA CLINICA LATINA LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1003433830
- **Authorized official:** NEDAL MEJALLI MD (REGISTERED AGENT)
- **Authorized official phone:** (414) 645-6665

## Contact information

- **Practice address:** 1238 S CESAR E CHAVEZ DR, MILWAUKEE, WI 53204-2267
- **Practice address phone:** (414) 645-6666
- **Practice address fax:** (414) 645-6732
- **Mailing address:** PO BOX 639, THIENSVILLE, WI 53092-0639
- **Mailing address phone:** (414) 645-6665
- **Mailing address fax:** (414) 645-6732

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 06/27/2020
- **Last updated:** 06/27/2020