# LA CLINICA MEDICA LATINA OF DES MOINES LLC

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

## Provider details

- **NPI number:** 1306965348
- **Authorized official:** AVA EAGLES ARNP (CLINIC OPERATIONS MGR CO OWNER)
- **Authorized official phone:** (515) 265-8200

## Contact information

- **Practice address:** 1300 DES MOINES ST, SUITE 106, DES MOINES, IA 50309-5502
- **Practice address phone:** (515) 265-8200
- **Practice address fax:** (515) 262-0045
- **Mailing address:** 2213 GRAND AVE, DES MOINES, IA 50312-5305
- **Mailing address phone:** (515) 237-3974
- **Mailing address fax:** (515) 883-2692

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | 25966 | IA | — |
| 363L00000X | Nurse Practitioner | A098023 | IA | Yes |

## Other

- **Enumeration date:** 03/29/2007
- **Last updated:** 03/23/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0785931 | — | IA |
| 05 | — | 0785956 | — | IA |
| 01 | — | DN6229 | RAILROAD MEDICARE | IA |