Healthcare Provider Details

I. General information

NPI: 1902431653
Provider Name (Legal Business Name): RECOVERY MOBILE CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2020
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4706 PRODUCT DR STE 1
WIXOM MI
48393-2071
US

IV. Provider business mailing address

7111 DIXIE HWY # 142
CLARKSTON MI
48346-2077
US

V. Phone/Fax

Practice location:
  • Phone: 248-567-2334
  • Fax:
Mailing address:
  • Phone: 248-563-5735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. JORDANA LEANNE LATOZAS
Title or Position: CEO/OWNER
Credential: ACNP
Phone: 248-563-5735