Provider Demographics
NPI:1164884821
Name:CENTRO MEDICO LATINO, PC
Entity Type:Organization
Organization Name:CENTRO MEDICO LATINO, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:MEYER
Authorized Official - Last Name:RISH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-333-0465
Mailing Address - Street 1:3541 RANDOLPH RD
Mailing Address - Street 2:STE 303
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-1082
Mailing Address - Country:US
Mailing Address - Phone:704-333-0465
Mailing Address - Fax:704-333-0466
Practice Address - Street 1:3541 RANDOLPH RD
Practice Address - Street 2:STE 303
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-1082
Practice Address - Country:US
Practice Address - Phone:704-333-0465
Practice Address - Fax:704-333-0466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-22
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty