Healthcare Provider Details

I. General information

NPI: 1578290854
Provider Name (Legal Business Name): LATIN ANGELS FOR HOMECARE LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2022
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

199 AVENUE B NW STE 200-3
WINTER HAVEN FL
33881-4546
US

IV. Provider business mailing address

7619 COOT ST
ORLANDO FL
32822-7705
US

V. Phone/Fax

Practice location:
  • Phone: 407-385-3470
  • Fax: 407-610-6756
Mailing address:
  • Phone: 407-385-3470
  • Fax: 407-610-6756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: PEDRO PENA CUESTA
Title or Position: CEO
Credential:
Phone: 786-238-5632