# CLINICA UNION

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

## Provider details

- **NPI number:** 1053787358
- **Authorized official:** MARIO RIVERA M.D (CEO)
- **Authorized official phone:** (404) 321-4692

## Contact information

- **Practice address:** 861 HOLCOMB BRIDGE RD, STE 200, ROSWELL, GA 30076-1900
- **Practice address phone:** (770) 992-4455
- **Mailing address:** 3369 BUFORD HWY NE, SUITE 810, BROOKHAVEN, GA 30329-3722
- **Mailing address phone:** (404) 321-4692

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 08/20/2015
- **Last updated:** 08/20/2015