Provider Demographics
NPI:1255714010
Name:EL CON HEALTH & WELLNESS CENTER LLC
Entity type:Organization
Organization Name:EL CON HEALTH & WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MENA
Authorized Official - Middle Name:
Authorized Official - Last Name:LATKAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-990-8383
Mailing Address - Street 1:1402 E PLACITA MESETA DORADA
Mailing Address - Street 2:
Mailing Address - City:ORO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85755-8683
Mailing Address - Country:US
Mailing Address - Phone:520-990-8382
Mailing Address - Fax:
Practice Address - Street 1:3402 E BROADWAY BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-5406
Practice Address - Country:US
Practice Address - Phone:520-318-5515
Practice Address - Fax:520-318-5518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-29
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ86009009133V00000X
AZRN068985363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & GynecologyGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty