Provider Demographics
NPI:1962010678
Name:MORRIS, LATOYA (SPECIALIST)
Entity Type:Individual
Prefix:
First Name:LATOYA
Middle Name:
Last Name:MORRIS
Suffix:
Gender:F
Credentials:SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 SARA CT APT 132
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687-6267
Mailing Address - Country:US
Mailing Address - Phone:707-720-5042
Mailing Address - Fax:
Practice Address - Street 1:901 SARA CT APT 132
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687-6267
Practice Address - Country:US
Practice Address - Phone:707-720-5042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-20
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAKK4883301744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Single Specialty