Provider Demographics
NPI:1215361282
Name:LATINO, GABRIEL MATTHEW (DC)
Entity Type:Individual
Prefix:DR
First Name:GABRIEL
Middle Name:MATTHEW
Last Name:LATINO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3703 CAMINO DEL RIO S
Mailing Address - Street 2:SUITE 220
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-4031
Mailing Address - Country:US
Mailing Address - Phone:646-644-1154
Mailing Address - Fax:
Practice Address - Street 1:3703 CAMINO DEL RIO S
Practice Address - Street 2:SUITE 210
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-4031
Practice Address - Country:US
Practice Address - Phone:646-644-1154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-27
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32709111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor