Provider Demographics
NPI:1235744293
Name:RAMOS, LATACHA NICOLE (PR)
Entity Type:Individual
Prefix:
First Name:LATACHA
Middle Name:NICOLE
Last Name:RAMOS
Suffix:
Gender:F
Credentials:PR
Other - Prefix:
Other - First Name:LATACHA
Other - Middle Name:NICOLE
Other - Last Name:RAMOS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PR
Mailing Address - Street 1:5606 STELLA CIR
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72118-3674
Mailing Address - Country:US
Mailing Address - Phone:501-554-5489
Mailing Address - Fax:
Practice Address - Street 1:8404 BASELINE RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72209-4339
Practice Address - Country:US
Practice Address - Phone:501-663-0708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-15
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR092251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management