Provider Demographics
NPI:1356141576
Name:VALENTINE, LATAYASIA DELORIS
Entity type:Individual
Prefix:
First Name:LATAYASIA
Middle Name:DELORIS
Last Name:VALENTINE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 E CAREY AVE APT 1114
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89030-1810
Mailing Address - Country:US
Mailing Address - Phone:702-704-1247
Mailing Address - Fax:
Practice Address - Street 1:4613 W DESERT INN RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-7116
Practice Address - Country:US
Practice Address - Phone:702-758-9539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-17
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant