Provider Demographics
NPI:1063879955
Name:LATIN CLINIC
Entity type:Organization
Organization Name:LATIN CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:VICTORTES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-247-1994
Mailing Address - Street 1:3961 S GESSNER RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77063-5135
Mailing Address - Country:US
Mailing Address - Phone:832-986-5007
Mailing Address - Fax:832-986-5097
Practice Address - Street 1:3961 S GESSNER RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77063-5135
Practice Address - Country:US
Practice Address - Phone:832-986-5007
Practice Address - Fax:832-986-5097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-22
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care