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Organization

CIVISTA CLINICAL SERVICES LLC

Active
Parent organization
CIVISTA MEDICAL CENTER
Other names
Civista Women's Health Center
Organization subpart
Yes

Provider details

NPI number
Legal business name
CIVISTA MEDICAL CENTER
Authorized official
MRS. IVETTE M MONTES DE OCA (PRACTICE MANAGER)
(301) 843-3150
Entity
Organization

Contact information

Practice address
11315 PEMBROOKE SQ STE 111, WALDORF, MD 20603-4806
(301) 843-3150
(301) 843-2560
Mailing address
5 GARRETT AVENUE, PO BOX 1070, LA PLATA, MD 20646-1070
(301) 609-4000

Taxonomy

Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
D0065304
MD

Other

Enumeration date
05/06/2010
Last updated
12/17/2019
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