Provider Demographics
NPI:1962073262
Name:LA CLINICA LATINA PLLC
Entity type:Organization
Organization Name:LA CLINICA LATINA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APN/ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:KANU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-303-9064
Mailing Address - Street 1:6859 S GESSNER RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-4613
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6859 S GESSNER RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-4613
Practice Address - Country:US
Practice Address - Phone:281-501-1889
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-07
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty