Provider Demographics
NPI:1770912230
Name:SIMS, LATASHA
Entity type:Individual
Prefix:
First Name:LATASHA
Middle Name:
Last Name:SIMS
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 1:7165 E UNIVERSITY DR STE 155
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85207-6412
Mailing Address - Country:US
Mailing Address - Phone:602-428-4557
Mailing Address - Fax:
Practice Address - Street 1:7165 E UNIVERSITY DR STE 155
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85207-6412
Practice Address - Country:US
Practice Address - Phone:602-428-4557
Practice Address - Fax:602-428-4561
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-05
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH145069164W00000X
246RP1900X, 261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No164W00000XNursing Service ProvidersLicensed Practical Nurse
No246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Multi-Specialty