Provider Demographics
NPI:1205596350
Name:LATINO LEADERSHIP, INC.
Entity type:Organization
Organization Name:LATINO LEADERSHIP, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARUCCI
Authorized Official - Middle Name:
Authorized Official - Last Name:GUZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-895-0801
Mailing Address - Street 1:8617 E COLONIAL DR STE 1600
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32817-3937
Mailing Address - Country:US
Mailing Address - Phone:407-895-0801
Mailing Address - Fax:407-895-0803
Practice Address - Street 1:4545 PLEASANT HILL RD STE 101
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34759-3400
Practice Address - Country:US
Practice Address - Phone:407-895-0801
Practice Address - Fax:407-895-0803
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LATINO LEADERSHIP, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-12-29
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHCC13239OtherHEALTH CARE CLINIC CERTIFICATE OF EXEMPTION