Provider Demographics
NPI:1790377299
Name:BEAMON, LATANYA MARVEL (CRT)
Entity Type:Individual
Prefix:
First Name:LATANYA
Middle Name:MARVEL
Last Name:BEAMON
Suffix:
Gender:F
Credentials:CRT
Other - Prefix:
Other - First Name:LATANYA
Other - Middle Name:MARVEL
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRT
Mailing Address - Street 1:263 W ALMY AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93706-5603
Mailing Address - Country:US
Mailing Address - Phone:559-721-8746
Mailing Address - Fax:
Practice Address - Street 1:263 W ALMY AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93706-5603
Practice Address - Country:US
Practice Address - Phone:559-721-8746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-05
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARHM000784732471M2300X, 2471C3402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiographyGroup - Single Specialty
No2471M2300XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMammographyGroup - Single Specialty