La Clinica Latina LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

LA CLINICA LATINA LLC

Practice address

1238 S Cesar E Chavez Dr
Milwaukee, WI 53204-2267

Phone

(414) 645-6666

Fax

(414) 645-6732

NPI assigned

Jun 27, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Nedal Mejalli, MD

Title

Registered Agent

Phone

(414) 645-6665

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1593216000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1593216000000",
    "number": "1003433830",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 639",
            "city": "THIENSVILLE",
            "state": "WI",
            "postal_code": "530920639",
            "telephone_number": "414-645-6665",
            "fax_number": "414-645-6732"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1238 S CESAR E CHAVEZ DR",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532042267",
            "telephone_number": "414-645-6666",
            "fax_number": "414-645-6732"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LA CLINICA LATINA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-27",
        "last_updated": "2020-06-27",
        "certification_date": "2020-06-27",
        "status": "A",
        "authorized_official_last_name": "MEJALLI",
        "authorized_official_first_name": "NEDAL",
        "authorized_official_title_or_position": "REGISTERED AGENT",
        "authorized_official_telephone_number": "414-645-6665",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinic/Center in Milwaukee, WI
• Providers in Milwaukee, WI by specialty
• Clinic/Center in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.