Provider Demographics
NPI:1356074488
Name:WEST, LATOYA M
Entity Type:Individual
Prefix:
First Name:LATOYA
Middle Name:M
Last Name:WEST
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 1:11200 SE HOLGATE BLVD APT 20
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97266-3377
Mailing Address - Country:US
Mailing Address - Phone:971-415-7830
Mailing Address - Fax:
Practice Address - Street 1:8900 NE VANCOUVER WAY
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97211-1350
Practice Address - Country:US
Practice Address - Phone:971-415-7830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-06
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORTHW000106794172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker