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Organization
SANTO NINO PEDIATRIC CLINIC, PC
Active
Organization
SANTO NINO PEDIATRIC CLINIC, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ALBERTO RICO NAFARRETE (OFFICE MANAGER)
(706) 855-7414
Entity
Organization
Contact information
Practice address
1722 CENTRAL AVE, AUGUSTA, GA 30904-5737
(706) 855-7414
(706) 364-0554
Mailing address
1722 CENTRAL AVE, AUGUSTA, GA 30904-5737
(706) 855-7414
(706) 364-0554
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003683189A
—
GA
01
—
10942549
CAROLINA CARE PLAN
GA
01
—
5444457
CCN(NETWORK)
GA
05
—
GPA837
—
SC
Enumeration date
05/08/2006
Last updated
08/17/2018
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