Healthcare Provider Details

I. General information

NPI: 1134893662
Provider Name (Legal Business Name): CHRISTIAN ANTHONY LATINO PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2021
Last Update Date: 10/22/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 4TH ST STE B
DAVIS CA
95616-4186
US

IV. Provider business mailing address

813 HARBOR BLVD STE 167
WEST SACRAMENTO CA
95691-2201
US

V. Phone/Fax

Practice location:
  • Phone: 530-761-5050
  • Fax:
Mailing address:
  • Phone: 530-205-3771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number32777
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: