Organization
SANTA MARIANITA CLINIC, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RODRIGO GOMEZ-CORDERO M.D (OWNER)
(402) 379-8717
Entity
Organization
Contact information
Practice address
1112 VERGES AVE, NORFOLK, NE 68701-3853
(402) 379-8717
(402) 379-0447
Mailing address
1112 VERGES AVE, NORFOLK, NE 68701-3853
(402) 379-8717
(402) 379-0447
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
15892
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
06484
BLUE CROSS BLUE SHIELD
NE
01
—
2407
MIDLANDS CHOICE
NE
Enumeration date
07/08/2006
Last updated
04/27/2012
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