Provider Demographics
NPI:1134893662
Name:LATINO, CHRISTIAN ANTHONY (PHD)
Entity type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:ANTHONY
Last Name:LATINO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:813 HARBOR BLVD STE 167
Mailing Address - Street 2:
Mailing Address - City:WEST SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95691-2201
Mailing Address - Country:US
Mailing Address - Phone:530-205-3771
Mailing Address - Fax:
Practice Address - Street 1:503 4TH ST STE B
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-4186
Practice Address - Country:US
Practice Address - Phone:530-761-5050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-07
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32777103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling