Provider Demographics
NPI:1396502795
Name:LATIC, SANDI
Entity type:Individual
Prefix:
First Name:SANDI
Middle Name:
Last Name:LATIC
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1185 JAMUNDA WALK APT D
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63129-1849
Mailing Address - Country:US
Mailing Address - Phone:314-262-6518
Mailing Address - Fax:
Practice Address - Street 1:1185 JAMUNDA WALK APT D
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63129-1849
Practice Address - Country:US
Practice Address - Phone:314-262-6518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-01
Last Update Date:2025-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No172A00000XOther Service ProvidersDriverGroup - Single Specialty
No344600000XTransportation ServicesTaxi
No347C00000XTransportation ServicesPrivate Vehicle
No347E00000XTransportation ServicesTransportation Broker