Provider Demographics
NPI:1083623516
Name:LATINO PSYCHOLOGICAL AND SOCIAL SERVICES
Entity Type:Organization
Organization Name:LATINO PSYCHOLOGICAL AND SOCIAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAZALDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-834-0757
Mailing Address - Street 1:120 W 5TH ST
Mailing Address - Street 2:STE300
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701-4641
Mailing Address - Country:US
Mailing Address - Phone:714-834-0757
Mailing Address - Fax:714-834-0848
Practice Address - Street 1:120 W 5TH ST
Practice Address - Street 2:STE300
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-4641
Practice Address - Country:US
Practice Address - Phone:714-834-0757
Practice Address - Fax:714-834-0848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY13614103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty