Provider Demographics
NPI:1518173723
Name:WEINMAN, LATIFA WELLMAN
Entity Type:Individual
Prefix:
First Name:LATIFA
Middle Name:WELLMAN
Last Name:WEINMAN
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 1:4247 NDCBU
Mailing Address - Street 2:
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571-6010
Mailing Address - Country:US
Mailing Address - Phone:505-758-1843
Mailing Address - Fax:
Practice Address - Street 1:509 RANCHITOS RD.
Practice Address - Street 2:BOX 4247
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-4327
Practice Address - Country:US
Practice Address - Phone:505-758-1843
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175L00000XOther Service ProvidersHomeopath