Provider Demographics
NPI:1265876924
Name:JANTZ, LATRISHA MARIE (LSA)
Entity type:Individual
Prefix:MISS
First Name:LATRISHA
Middle Name:MARIE
Last Name:JANTZ
Suffix:
Gender:F
Credentials:LSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 E ARAPAHO RD STE 600
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-2400
Mailing Address - Country:US
Mailing Address - Phone:469-250-4422
Mailing Address - Fax:
Practice Address - Street 1:9101 N CENTRAL EXPY
Practice Address - Street 2:SUITE 600
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-5927
Practice Address - Country:US
Practice Address - Phone:214-823-1691
Practice Address - Fax:214-821-7089
Is Sole Proprietor?:No
Enumeration Date:2013-04-24
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA00668246ZC0007X
143216246ZS0410X
TX154638246ZC0007X
TX310225164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist
No164X00000XNursing Service ProvidersLicensed Vocational Nurse