Provider Demographics
NPI:1821723735
Name:WARREN, LATASHA D
Entity Type:Individual
Prefix:
First Name:LATASHA
Middle Name:D
Last Name:WARREN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2805 CENTRAL AVE APT 539
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44115-3182
Mailing Address - Country:US
Mailing Address - Phone:216-387-0902
Mailing Address - Fax:
Practice Address - Street 1:2805 CENTRAL AVE APT 539
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44115-3182
Practice Address - Country:US
Practice Address - Phone:216-387-0902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-24
Last Update Date:2022-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health