Healthcare Provider Details

I. General information

NPI: 1275851859
Provider Name (Legal Business Name): CENTRO LATINOAMERICANO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2010
Last Update Date: 05/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

944 W 5TH AVE
EUGENE OR
97402-5106
US

IV. Provider business mailing address

944 W 5TH AVE
EUGENE OR
97402-5106
US

V. Phone/Fax

Practice location:
  • Phone: 541-687-2667
  • Fax: 541-284-2139
Mailing address:
  • Phone: 541-687-2667
  • Fax: 541-284-2139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier163WA0400X
Identifier TypeOTHER
Identifier StateOR
Identifier IssuerHIPAA

VIII. Authorized Official

Name: DR. MARCELA MENDOZA
Title or Position: DIRECTOR
Credential: PH.D.
Phone: 541-687-2667