Provider Demographics
NPI:1184482572
Name:LATO, JOHNNY EDGIL (DD,FIRST AID, WC)
Entity type:Individual
Prefix:MR
First Name:JOHNNY
Middle Name:EDGIL
Last Name:LATO
Suffix:
Gender:M
Credentials:DD,FIRST AID, WC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5126 TEALBY LN
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2969
Mailing Address - Country:US
Mailing Address - Phone:314-766-8294
Mailing Address - Fax:
Practice Address - Street 1:5126 TEALBY LN
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2969
Practice Address - Country:US
Practice Address - Phone:314-766-8294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver