Provider Demographics
NPI:1235465386
Name:LATORRE, LUIS E (MS)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:E
Last Name:LATORRE
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14340 SW 57TH LN APT 207
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-1057
Mailing Address - Country:US
Mailing Address - Phone:786-350-0313
Mailing Address - Fax:305-635-3524
Practice Address - Street 1:14340 SW 57TH LN APT 207
Practice Address - Street 2:
Practice Address - City:KENDALL
Practice Address - State:FL
Practice Address - Zip Code:33183-1057
Practice Address - Country:US
Practice Address - Phone:786-503-3392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-26
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001065500Medicaid