Provider Demographics
NPI:1922722081
Name:ARCENEAUX, LATORA EN'E
Entity Type:Individual
Prefix:
First Name:LATORA
Middle Name:EN'E
Last Name:ARCENEAUX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TORA
Other - Middle Name:EN'E
Other - Last Name:PORTIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8731 CROTEAU DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77044-1305
Mailing Address - Country:US
Mailing Address - Phone:281-777-3105
Mailing Address - Fax:
Practice Address - Street 1:8731 CROTEAU DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77044-1305
Practice Address - Country:US
Practice Address - Phone:281-777-3105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX343900000X
343900000X
TX08570030343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXNONEMedicaid