Organization
LA CLINICA LATINA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NEDAL MEJALLI MD (REGISTERED AGENT)
(414) 645-6665
Entity
Organization
Contact information
Practice address
1238 S CESAR E CHAVEZ DR, MILWAUKEE, WI 53204-2267
(414) 645-6666
(414) 645-6732
Mailing address
PO BOX 639, THIENSVILLE, WI 53092-0639
(414) 645-6665
(414) 645-6732
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
06/27/2020
Last updated
06/27/2020
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