Organization
INFANT JESUS CHILDRENS CLINIC PLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PATRICIA D GONZALES MD (PRESIDENT)
(804) 458-1430
Entity
Organization
Contact information
Practice address
210 TEMPLE AVE, COLONIAL HEIGHTS, VA 23834-2828
(804) 520-6137
(804) 520-7394
Mailing address
210 TEMPLE AVE, COLONIAL HEIGHTS, VA 23834-2828
(804) 520-6137
(804) 520-7394
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
120154
UNITED HEALTH CARE
—
01
—
17660
CARENET
—
01
—
214596
ANTHEM
—
01
—
214598
ANTHEM
—
01
—
23468
SENTARA
—
Enumeration date
07/12/2006
Last updated
08/22/2020
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