Provider Demographics
NPI:1265906366
Name:RANDILE, LATORIA (CNIM)
Entity type:Individual
Prefix:
First Name:LATORIA
Middle Name:
Last Name:RANDILE
Suffix:
Gender:F
Credentials:CNIM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 E SOUTHLAKE BLVD STE 150
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-6276
Mailing Address - Country:US
Mailing Address - Phone:254-221-2900
Mailing Address - Fax:
Practice Address - Street 1:251 E SOUTHLAKE BLVD STE 150
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6276
Practice Address - Country:US
Practice Address - Phone:254-221-2900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-11
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic