Provider Demographics
NPI:1639581911
Name:IRVING, LATASHIA RENAE (MD)
Entity Type:Individual
Prefix:
First Name:LATASHIA
Middle Name:RENAE
Last Name:IRVING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7614 CLAIBORNE ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77016-3908
Mailing Address - Country:US
Mailing Address - Phone:832-277-5843
Mailing Address - Fax:
Practice Address - Street 1:400 N SAM HOUSTON PKWY E STE 280
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77060-3548
Practice Address - Country:US
Practice Address - Phone:713-659-9309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-21
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS3679207Q00000X
LA308433207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine