Provider Demographics
NPI:1487194395
Name:HILL, LATEISHA MARIE
Entity Type:Individual
Prefix:
First Name:LATEISHA
Middle Name:MARIE
Last Name:HILL
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 1:5115 N MESA ST
Mailing Address - Street 2:APT A333
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-5858
Mailing Address - Country:US
Mailing Address - Phone:254-733-4030
Mailing Address - Fax:
Practice Address - Street 1:4000 DYER ST
Practice Address - Street 2:SUITE I
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79930-6663
Practice Address - Country:US
Practice Address - Phone:254-733-4030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-27
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15911771744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management