Provider Demographics
NPI:1356175392
Name:LA LUZ CENTER
Entity type:Organization
Organization Name:LA LUZ CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LEONARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:LOBATO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-938-5131
Mailing Address - Street 1:17560 GREGER ST
Mailing Address - Street 2:
Mailing Address - City:SONOMA
Mailing Address - State:CA
Mailing Address - Zip Code:95476-3617
Mailing Address - Country:US
Mailing Address - Phone:707-938-5131
Mailing Address - Fax:707-996-1287
Practice Address - Street 1:17560 GREGER ST
Practice Address - Street 2:
Practice Address - City:SONOMA
Practice Address - State:CA
Practice Address - Zip Code:95476-3617
Practice Address - Country:US
Practice Address - Phone:707-938-5131
Practice Address - Fax:707-996-1287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-30
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251X00000XAgenciesSupports Brokerage