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Organization
CONSULTORIO MEDICO LATINO
Active
Organization
CONSULTORIO MEDICO LATINO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHANIE JAQUEZ (SOLE MBR)
(843) 735-1887
Entity
Organization
Contact information
Practice address
2810 ASHLEY PHOSPHATE RD STE B4, NORTH CHARLESTON, SC 29418-6406
(843) 553-7744
(843) 553-7734
Mailing address
2810 ASHLEY PHOSPHATE RD STE B4, NORTH CHARLESTON, SC 29418-6406
(843) 553-7744
(843) 553-7734
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
03/03/2020
Last updated
07/06/2021
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