Provider Demographics
NPI:1801131552
Name:LATHAM, VARONECA (LVN)
Entity type:Individual
Prefix:
First Name:VARONECA
Middle Name:
Last Name:LATHAM
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1038 N TURNER AVE
Mailing Address - Street 2:UNIT 152
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91764-5331
Mailing Address - Country:US
Mailing Address - Phone:909-275-0370
Mailing Address - Fax:909-296-5233
Practice Address - Street 1:1038 N TURNER AVE
Practice Address - Street 2:UNIT 152
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91764-5331
Practice Address - Country:US
Practice Address - Phone:909-275-0370
Practice Address - Fax:909-296-5233
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-06
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA161795164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA161795OtherLVN