Provider Demographics
NPI:1669286944
Name:LATHAM, YOLANDA L
Entity type:Individual
Prefix:
First Name:YOLANDA
Middle Name:L
Last Name:LATHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11765 STATE HIGHWAY 96
Mailing Address - Street 2:
Mailing Address - City:HOOPA
Mailing Address - State:CA
Mailing Address - Zip Code:95546-9684
Mailing Address - Country:US
Mailing Address - Phone:707-599-7653
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 1102
Practice Address - Street 2:
Practice Address - City:HOOPA
Practice Address - State:CA
Practice Address - Zip Code:95546-1102
Practice Address - Country:US
Practice Address - Phone:707-599-7653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-05
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker