Basic Information
| Provider Information | |||||||||
| NPI: | 1821529728 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHILDREN'S INTERNATIONAL, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 59101 AMBER ST | ||||||||
| Address2: | |||||||||
| City: | SLIDELL | ||||||||
| State: | LA | ||||||||
| PostalCode: | 704613708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9856461580 | ||||||||
| FaxNumber: | 9856461579 | ||||||||
| Practice Location | |||||||||
| Address1: | 42124 VETERANS AVE | ||||||||
| Address2: | |||||||||
| City: | HAMMOND | ||||||||
| State: | LA | ||||||||
| PostalCode: | 704031427 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9855430565 | ||||||||
| FaxNumber: | 9855430567 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2017 | ||||||||
| LastUpdateDate: | 03/22/2017 | ||||||||
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| AuthorizedOfficialLastName: | HERNANDEZ | ||||||||
| AuthorizedOfficialFirstName: | EDUARDO | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 9856461580 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
No ID Information.