Provider Demographics
NPI:1578289567
Name:COLE, LAMONTA ANTOINE JR
Entity Type:Individual
Prefix:
First Name:LAMONTA
Middle Name:ANTOINE
Last Name:COLE
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 HARRIS AVE APT 6
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89101-2688
Mailing Address - Country:US
Mailing Address - Phone:702-854-8505
Mailing Address - Fax:
Practice Address - Street 1:1600 HARRIS AVE APT 6
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89101-2688
Practice Address - Country:US
Practice Address - Phone:702-854-8505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-12
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant