Healthcare Provider Details

I. General information

NPI: 1235318635
Provider Name (Legal Business Name): THE LATINO COMMISSION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2007
Last Update Date: 06/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 SNEATH LN STE 307
SAN BRUNO CA
94066-2349
US

IV. Provider business mailing address

1001 SNEATH LN STE 307
SAN BRUNO CA
94066-2349
US

V. Phone/Fax

Practice location:
  • Phone: 650-244-1444
  • Fax: 650-244-1447
Mailing address:
  • Phone: 650-244-0306
  • Fax: 650-244-1447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARIA NEWSON
Title or Position: ASSOCIATE DIRECTOR OF OPERATIONS
Credential:
Phone: 650-244-1442