Provider Demographics
NPI:1982848925
Name:LATAY MEDICAL SERVICES, INC.
Entity Type:Organization
Organization Name:LATAY MEDICAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:BOLADEMI
Authorized Official - Middle Name:
Authorized Official - Last Name:ADETOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-538-9280
Mailing Address - Street 1:14612 CRENSHAW BLVD
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90249-3147
Mailing Address - Country:US
Mailing Address - Phone:310-538-9280
Mailing Address - Fax:310-538-9257
Practice Address - Street 1:14612 CRENSHAW BLVD
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90249-3147
Practice Address - Country:US
Practice Address - Phone:310-538-9280
Practice Address - Fax:310-538-9257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-21
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103127332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA103127OtherCA HMDR