Healthcare Provider Details

I. General information

NPI: 1255714010
Provider Name (Legal Business Name): EL CON HEALTH & WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2015
Last Update Date: 05/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3402 E BROADWAY BLVD
TUCSON AZ
85716-5406
US

IV. Provider business mailing address

1402 E PLACITA MESETA DORADA
ORO VALLEY AZ
85755-8683
US

V. Phone/Fax

Practice location:
  • Phone: 520-318-5515
  • Fax: 520-318-5518
Mailing address:
  • Phone: 520-990-8382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86009009
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberRN068985
License Number StateAZ

VIII. Authorized Official

Name: MRS. MENA LATKAS
Title or Position: OWNER
Credential:
Phone: 520-990-8383