Provider Demographics
NPI:1619563673
Name:LATAP, REY JOHN (MSN-FNP-C)
Entity Type:Individual
Prefix:
First Name:REY JOHN
Middle Name:
Last Name:LATAP
Suffix:
Gender:M
Credentials:MSN-FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26445 BAY AVE
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92555-2518
Mailing Address - Country:US
Mailing Address - Phone:806-317-0825
Mailing Address - Fax:
Practice Address - Street 1:26445 BAY AVE
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92555-2518
Practice Address - Country:US
Practice Address - Phone:806-317-0825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-14
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95016219363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily