Healthcare Provider Details

I. General information

NPI: 1518940543
Provider Name (Legal Business Name): CLINICA LATINA, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2005
Last Update Date: 08/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1238 S CESAR E CHAVEZ DR
MILWAUKEE WI
53204-2267
US

IV. Provider business mailing address

6400 INDUSTRIAL LOOP
GREENDALE WI
53129-2452
US

V. Phone/Fax

Practice location:
  • Phone: 414-645-6665
  • Fax: 414-645-6732
Mailing address:
  • Phone: 414-423-4100
  • Fax: 414-423-4134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: LEONARDO APONTE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 414-645-6665