Su Salud Clinic Psc

NPI #1689941932 in Fort Wayne, Indiana

Provider Information

NPI Number: 1689941932
Entity Type: Organization
Organization Name: Su Salud Clinic Psc
Primary Specialty: Family Medicine
Enumeration Date: Nov 30, 2011
Last Updated: Jul 16, 2012

Practice Location

Address: 4101 DIPLOMAT PLAZA CTR
City: Fort Wayne
State: Indiana
ZIP Code: 46806-4531
Phone: (260) 444-5695

Authorized Official

Name: DR. MARIO AUGUSTO GOMEZ, MD
Title: FAMILY PRACTICE/OWNER
Phone: (260) 444-5695

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Family Medicine	207Q00000X	Primary

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