Provider Demographics
NPI:1568030955
Name:MCCRIMMON, LATARSHA
Entity Type:Individual
Prefix:
First Name:LATARSHA
Middle Name:
Last Name:MCCRIMMON
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 1:7003 VILLA DEL SOL DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77083-2333
Mailing Address - Country:US
Mailing Address - Phone:281-960-1391
Mailing Address - Fax:
Practice Address - Street 1:7003 VILLA DEL SOL DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77083-2333
Practice Address - Country:US
Practice Address - Phone:281-960-1391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-14
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX00803540172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver