Provider Demographics
NPI:1730582537
Name:LATINO HEATLH CARE GROUP
Entity type:Organization
Organization Name:LATINO HEATLH CARE GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:YVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:QUINTANA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:530-501-4530
Mailing Address - Street 1:4101 INNOVATOR DR
Mailing Address - Street 2:AP 1202
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834-3851
Mailing Address - Country:US
Mailing Address - Phone:916-799-6073
Mailing Address - Fax:
Practice Address - Street 1:295 E ST
Practice Address - Street 2:SUITE C
Practice Address - City:WILLIAMS
Practice Address - State:CA
Practice Address - Zip Code:95987-5813
Practice Address - Country:US
Practice Address - Phone:530-501-4530
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-07
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59157122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty