Provider Demographics
NPI:1427422047
Name:DR. LATINO FAMILY CLINIC PLLC
Entity type:Organization
Organization Name:DR. LATINO FAMILY CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:ORDONEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-558-0722
Mailing Address - Street 1:2014 S TEXAS AVE
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-1833
Mailing Address - Country:US
Mailing Address - Phone:979-703-7721
Mailing Address - Fax:
Practice Address - Street 1:2014 S TEXAS AVE
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-1833
Practice Address - Country:US
Practice Address - Phone:979-703-7721
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-19
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty