Provider Demographics
NPI:1881166171
Name:PERRY, LATASHA A
Entity type:Individual
Prefix:
First Name:LATASHA
Middle Name:A
Last Name:PERRY
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 1:1400 NE 125TH ST
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-6034
Mailing Address - Country:US
Mailing Address - Phone:130-591-5890
Mailing Address - Fax:305-392-1391
Practice Address - Street 1:1400 NE 125TH ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33161-6034
Practice Address - Country:US
Practice Address - Phone:130-591-5890
Practice Address - Fax:305-392-1391
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-26
Last Update Date:2018-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator