Provider Demographics
NPI:1588216675
Name:HICKS, LATOYA (LVN)
Entity Type:Individual
Prefix:MS
First Name:LATOYA
Middle Name:
Last Name:HICKS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:LATOYA
Other - Middle Name:
Other - Last Name:HICKS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NURSE
Mailing Address - Street 1:5015 W PICO BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-4127
Mailing Address - Country:US
Mailing Address - Phone:323-653-1633
Mailing Address - Fax:
Practice Address - Street 1:5015 W PICO BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90019-4127
Practice Address - Country:US
Practice Address - Phone:323-653-1633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-10
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA228146164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse