1205596350 NPI number — LATINO LEADERSHIP, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205596350 NPI number — LATINO LEADERSHIP, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LATINO LEADERSHIP, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205596350
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/20/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8617 E COLONIAL DR STE 1600
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32817-3937
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-895-0801
Provider Business Mailing Address Fax Number:
407-895-0803

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4545 PLEASANT HILL RD STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KISSIMMEE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34759-3400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-895-0801
Provider Business Practice Location Address Fax Number:
407-895-0803
Provider Enumeration Date:
12/29/2021

Additional Information

Authorized Official

Authorized Official Last Name:
GUZMAN
Authorized Official First Name:
MARUCCI
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
407-895-0801

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: HCC13239 . This is a "HEALTH CARE CLINIC CERTIFICATE OF EXEMPTION" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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