Provider Demographics
NPI:1568691434
Name:BANKS, LATUNYA DENISE
Entity Type:Individual
Prefix:MS
First Name:LATUNYA
Middle Name:DENISE
Last Name:BANKS
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 1:7431 HYSSOP DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91739-9739
Mailing Address - Country:US
Mailing Address - Phone:626-616-4128
Mailing Address - Fax:
Practice Address - Street 1:316 E E ST
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91764-3712
Practice Address - Country:US
Practice Address - Phone:909-983-4466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-13
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker