# CLINICA VITAL, LLC

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

## Provider details

- **NPI number:** 1780374645
- **Authorized official:** MELISSA SALCIDO (CEO)
- **Authorized official phone:** (770) 797-5167

## Contact information

- **Practice address:** 3661 CLAIRMONT RD, CHAMBLEE, GA 30341-4907
- **Practice address phone:** (770) 797-5167
- **Practice address fax:** (404) 891-6343
- **Mailing address:** 3661 CLAIRMONT RD, CHAMBLEE, GA 30341-4907
- **Mailing address phone:** (770) 797-5167
- **Mailing address fax:** (404) 891-6343

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 208000000X | Pediatrics Physician | — | NULL | — |
| 208000000X | Pediatrics Physician | — | — | — |

## Other

- **Enumeration date:** 05/12/2023
- **Last updated:** 05/12/2023