Basic Information
Provider Information | |||||||||
NPI: | 1740578087 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | THE LATINO COMMISSON | ||||||||
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: | 6502441444 | ||||||||
FaxNumber: | 6502441447 | ||||||||
Practice Location | |||||||||
Address1: | 401 BRIARFIELD WAY | ||||||||
Address2: |   | ||||||||
City: | BELMONT | ||||||||
State: | CA | ||||||||
PostalCode: | 94002 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6503694598 | ||||||||
FaxNumber: | 6503694619 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/20/2011 | ||||||||
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: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 324500000X |   |   | Y |   | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility |   |
No ID Information.