Provider Demographics
NPI:1073085817
Name:OSUNDE, LATOYA I
Entity Type:Individual
Prefix:
First Name:LATOYA
Middle Name:I
Last Name:OSUNDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2936 W ROYAL LN APT 2142
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-6243
Mailing Address - Country:US
Mailing Address - Phone:210-843-5489
Mailing Address - Fax:
Practice Address - Street 1:2936 W ROYAL LN APT 2142
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-6243
Practice Address - Country:US
Practice Address - Phone:210-843-5489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-18
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker