Healthcare Provider Details

I. General information

NPI: 1508221623
Provider Name (Legal Business Name): THE LATINO COMMISSION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2015
Last Update Date: 12/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 GRAND AVE
SOUTH SAN FRANCISCO CA
94080-3606
US

IV. Provider business mailing address

301 GRAND AVE
SOUTH SAN FRANCISCO CA
94080-3606
US

V. Phone/Fax

Practice location:
  • Phone: 650-244-1441
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number410020IN
License Number StateCA

VIII. Authorized Official

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