Provider Demographics
NPI:1770200941
Name:BURGINS, LATROYA JA'QUEX
Entity type:Individual
Prefix:
First Name:LATROYA
Middle Name:JA'QUEX
Last Name:BURGINS
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 1:1660 MAXEN DR
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44307-1031
Mailing Address - Country:US
Mailing Address - Phone:234-334-8598
Mailing Address - Fax:
Practice Address - Street 1:1660 MAXEN DR
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44307-1031
Practice Address - Country:US
Practice Address - Phone:234-334-8598
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-27
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor