Healthcare Provider Details

I. General information

NPI: 1477488013
Provider Name (Legal Business Name): THE LATINO COMMISSION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 7TH AVE
SAN BRUNO CA
94066-4522
US

IV. Provider business mailing address

988 JOLEEN CT
HAYWARD CA
94544-5778
US

V. Phone/Fax

Practice location:
  • Phone: 650-240-3113
  • Fax:
Mailing address:
  • Phone: 510-872-8575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: MS. MASSIELLE BERMUDEZ
Title or Position: REGISTERED COUNSELOR
Credential: SUDRC#19758
Phone: 510-872-8575