=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235465386
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LUIS E. LATORRE M.S.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/26/2009
-----------------------------------------------------
Last Update Date | 01/17/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14340 SW 57TH LN APT 207
-----------------------------------------------------
City | KENDALL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33183-1057
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-503-3392
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14340 SW 57TH LN APT 207
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33183-1057
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-350-0313
-----------------------------------------------------
Fax | 305-635-3524
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106S00000X
-----------------------------------------------------
Taxonomy Name | Behavior Technician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------