Healthcare Provider Details

I. General information

NPI: 1588700264
Provider Name (Legal Business Name): LATINO COMMISSION ON ALCOHOL AND DRUG ABUSE SERVICES OF SAN MATEO COUN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 08/12/2024
Certification Date: 08/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1724 BRYANT ST
SAN FRANCISCO CA
94110
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 415-558-9125
  • Fax:
Mailing address:
  • Phone: 650-244-1444
  • Fax: 650-244-1447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number380055BN
License Number StateCA

VIII. Authorized Official

Name: MISS DEBRA CAMARILLO
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 650-244-1442