Basic Information
| Provider Information | |||||||||
| NPI: | 1528388220 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VIDA NUEVA AT CASA GUADALUPE OB | ||||||||
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| Mailing Information | |||||||||
| Address1: | 218 N 2ND ST | ||||||||
| Address2: | |||||||||
| City: | ALLENTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 181023508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6108418400 | ||||||||
| FaxNumber: | 6108418401 | ||||||||
| Practice Location | |||||||||
| Address1: | 218 N 2ND ST | ||||||||
| Address2: | |||||||||
| City: | ALLENTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 181023508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6108418400 | ||||||||
| FaxNumber: | 6108418401 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2010 | ||||||||
| LastUpdateDate: | 06/03/2010 | ||||||||
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| AuthorizedOfficialLastName: | SECKINGER | ||||||||
| AuthorizedOfficialFirstName: | LEE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRACTICE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 6104334680 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | NEIGHBORHOOD HEALTH CENTERS OF THE LEHIGH VALLEY | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM2500X | Y | Ambulatory Health Care Facilities | Clinic/Center | Medical Specialty |
No ID Information.