Provider Demographics
NPI:1508024902
Name:LATTA, LYNDA (PMHCNS-BC)
Entity Type:Individual
Prefix:
First Name:LYNDA
Middle Name:
Last Name:LATTA
Suffix:
Gender:F
Credentials:PMHCNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11429 HICKORY AVE
Mailing Address - Street 2:
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-2013
Mailing Address - Country:US
Mailing Address - Phone:760-948-0919
Mailing Address - Fax:760-990-2249
Practice Address - Street 1:11429 HICKORY AVE
Practice Address - Street 2:
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-2013
Practice Address - Country:US
Practice Address - Phone:760-948-0919
Practice Address - Fax:760-990-2249
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-02
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA202921163WP0809X
CACNS 1016364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult