Provider Demographics
NPI:1346839636
Name:ROUSE, LATRANAE KENYETTE
Entity Type:Individual
Prefix:
First Name:LATRANAE
Middle Name:KENYETTE
Last Name:ROUSE
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 1:6751 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90043-4460
Mailing Address - Country:US
Mailing Address - Phone:323-210-5752
Mailing Address - Fax:
Practice Address - Street 1:6751 4TH AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90043-4460
Practice Address - Country:US
Practice Address - Phone:323-210-5752
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-12
Last Update Date:2022-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management