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Organization

LA CLINICA DEL PUEBLO, INC.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MICAELA ACUNA (PATIENT REVENUE MANAGER)
(240) 582-8828
Entity
Organization

Contact information

Practice address
2831 15TH STREET NW, WASHINGTON, DC 20009-4607
(202) 462-4788
(202) 332-0085
Mailing address
2831 15TH STREET NW, WASHINGTON, DC 20009-4607
(202) 462-4788
(202) 332-0085

Taxonomy

Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
261Q00000X
Clinic/Center
52194XXXX650001047
DC
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)

Other

Enumeration date
07/16/2007
Last updated
10/09/2024
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