Provider Demographics
NPI:1740961911
Name:LANGSTON, JAVONTAE
Entity type:Individual
Prefix:
First Name:JAVONTAE
Middle Name:
Last Name:LANGSTON
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 1:307 N SANDAL
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85205-5885
Mailing Address - Country:US
Mailing Address - Phone:623-252-9215
Mailing Address - Fax:
Practice Address - Street 1:307 N SANDAL
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205-5885
Practice Address - Country:US
Practice Address - Phone:623-252-9215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-28
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health