Basic Information
| Provider Information | |||||||||
| NPI: | 1588700264 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THE LATINO COMMISSION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1001 SNEATH LN STE 307 | ||||||||
| Address2: | |||||||||
| City: | SAN BRUNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940662349 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6502441444 | ||||||||
| FaxNumber: | 6502441447 | ||||||||
| Practice Location | |||||||||
| Address1: | 1724 BRYANT ST | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4155589125 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2007 | ||||||||
| LastUpdateDate: | 06/06/2018 | ||||||||
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| AuthorizedOfficialLastName: | CAMARILLO | ||||||||
| AuthorizedOfficialFirstName: | DEBRA | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 6502441442 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MISS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3245S0500X | 380055BN | CA | Y | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility | Substance Abuse Treatment, Children |
ID Information
| ID | Type | State | Issuer | Description | 38932 | 01 | CA | AVIVA HOUSE -MOM | OTHER | 38935 | 01 | CA | AVIVA-BABIES | OTHER |