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Organization
LA CLINICA MEDICA LATINA OF DES MOINES LLC
Active
Organization
LA CLINICA MEDICA LATINA OF DES MOINES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AVA EAGLES ARNP (CLINIC OPERATIONS MGR CO OWNER)
(515) 265-8200
Entity
Organization
Contact information
Practice address
1300 DES MOINES ST, SUITE 106, DES MOINES, IA 50309-5502
(515) 265-8200
(515) 262-0045
Mailing address
2213 GRAND AVE, DES MOINES, IA 50312-5305
(515) 237-3974
(515) 883-2692
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
25966
IA
363L00000X
Nurse Practitioner
Primary
A098023
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0785931
—
IA
05
—
0785956
—
IA
01
—
DN6229
RAILROAD MEDICARE
IA
Enumeration date
03/29/2007
Last updated
03/23/2011
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