Healthcare Provider Details

I. General information

NPI: 1376308601
Provider Name (Legal Business Name): LATINO CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2024
Last Update Date: 02/15/2024
Certification Date: 02/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5847 S 16TH ST
PHOENIX AZ
85040-3512
US

IV. Provider business mailing address

3140 N 35TH AVE STE 7
PHOENIX AZ
85017-5270
US

V. Phone/Fax

Practice location:
  • Phone: 602-609-4107
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: YURI HERNANDEZ
Title or Position: ADMIN
Credential:
Phone: 602-353-6656