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NPI Code Detail

MEDICARE: ASD LATINOS UNLIMITED LLC

MEDICARE: ASD LATINOS UNLIMITED LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1750892337
Entity Type Code : Organization
Provider Name (Legal Business Name) : ASD LATINOS UNLIMITED LLC
Provider Business Mailing Address
First Line : 27856 LENOX AVE
Second Line :
City : MADISON HEIGHTS
State : MI
Zip : 48071-2730
Country : US
Telephone Number : 248-254-2616
Fax Number :
Provider Business Practice Location Address
First Line : 51111 WOODWARD AVE STE 150
Second Line :
City : PONTIAC
State : MI
Zip : 48342-5037
Country : US
Telephone Number : 248-977-5310
Fax Number : 248-920-0386
Authorized Official
Title or Position : CEO
Name : JOCELIN MARIA HENRIQUEZ
Credential : B.A.
Telephone Number : 248-254-2616
Provider Enumeration Date : 10/23/2017
Last Update Date : 03/11/2024

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Directions to “ASD LATINOS UNLIMITED LLC ” Practice Location

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