Provider Demographics
NPI:1851831218
Name:CARTER, LATISHA SAMANTHA
Entity Type:Individual
Prefix:
First Name:LATISHA
Middle Name:SAMANTHA
Last Name:CARTER
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 1:521 W 97TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90044-4615
Mailing Address - Country:US
Mailing Address - Phone:323-684-5485
Mailing Address - Fax:
Practice Address - Street 1:521 W 97TH ST.
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90044
Practice Address - Country:US
Practice Address - Phone:323-684-5485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-06
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA687301164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse