Healthcare Provider Details

I. General information

NPI: 1962233999
Provider Name (Legal Business Name): LATAM MEDICAL NETWORK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2024
Last Update Date: 11/06/2026
Certification Date: 11/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE 3ERA Y CALLE CENTRAL
DAVID CENTRAL
04010
PA

IV. Provider business mailing address

333 H ST STE 5000
CHULA VISTA CA
91910-5561
US

V. Phone/Fax

Practice location:
  • Phone: 507-774-0128
  • Fax:
Mailing address:
  • Phone: 619-988-6512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: ALBERTO CARSON
Title or Position: DIRECTOR
Credential:
Phone: 619-988-6512