Provider Demographics
NPI:1962012518
Name:BECKETT, LATINA
Entity Type:Individual
Prefix:MISS
First Name:LATINA
Middle Name:
Last Name:BECKETT
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 1:12501 CHANDLER BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:VALLEY VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91607-1955
Mailing Address - Country:US
Mailing Address - Phone:818-821-6012
Mailing Address - Fax:818-821-6014
Practice Address - Street 1:2335 MOUNTAIN AVE
Practice Address - Street 2:
Practice Address - City:DUARTE
Practice Address - State:CA
Practice Address - Zip Code:91010-3559
Practice Address - Country:US
Practice Address - Phone:818-821-6012
Practice Address - Fax:818-821-6014
Is Sole Proprietor?:No
Enumeration Date:2020-08-07
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program