Basic Information
Provider Information | |||||||||
NPI: | 1235318635 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | THE LATINO COMMISSION | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1001 SNEATH LN STE 307 | ||||||||
Address2: |   | ||||||||
City: | SAN BRUNO | ||||||||
State: | CA | ||||||||
PostalCode: | 940662349 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6502440306 | ||||||||
FaxNumber: | 6502441447 | ||||||||
Practice Location | |||||||||
Address1: | 1001 SNEATH LN STE 307 | ||||||||
Address2: |   | ||||||||
City: | SAN BRUNO | ||||||||
State: | CA | ||||||||
PostalCode: | 940662349 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6502441444 | ||||||||
FaxNumber: | 6502441447 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 11/01/2007 | ||||||||
LastUpdateDate: | 06/06/2018 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | NEWSON | ||||||||
AuthorizedOfficialFirstName: | MARIA | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | ASSOCIATE DIRECTOR OF OPERATIONS | ||||||||
AuthorizedOfficialTelephone: | 6502441442 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MRS. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 324500000X |   |   | Y |   | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility |   |
ID Information
ID | Type | State | Issuer | Description | 38472 | 01 | CA | QUETZAL | OTHER | 38935 | 01 | CA | AVIVA-BABIES | OTHER | 38932 | 01 | CA | AVIVA -MOM | OTHER | 97037 | 01 | CA | OLLIN | OTHER | 41491 | 01 | CA | ENTRE FAMILIA - OP | OTHER |