Provider Demographics
NPI:1154554988
Name:LA FRONTERA CENTER, INC.
Entity type:Organization
Organization Name:LA FRONTERA CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:TERI
Authorized Official - Middle Name:L
Authorized Official - Last Name:LAGUNAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-838-3901
Mailing Address - Street 1:504 W 29TH ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85713-3353
Mailing Address - Country:US
Mailing Address - Phone:520-838-3901
Mailing Address - Fax:520-792-0654
Practice Address - Street 1:410 S 6TH AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85701-2312
Practice Address - Country:US
Practice Address - Phone:520-838-5610
Practice Address - Fax:520-622-3395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-27
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH-3360251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management