Provider Demographics
NPI:1932484425
Name:AZUMAH, LATESHA DARLENE
Entity Type:Individual
Prefix:MRS
First Name:LATESHA
Middle Name:DARLENE
Last Name:AZUMAH
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 1:4411 E. KINGS CANYON RD
Mailing Address - Street 2:BLDG. #319
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93702
Mailing Address - Country:US
Mailing Address - Phone:559-453-6227
Mailing Address - Fax:559-452-8901
Practice Address - Street 1:4411 E. KINGS CANYON RD
Practice Address - Street 2:BLDG. #319
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93702
Practice Address - Country:US
Practice Address - Phone:559-453-6227
Practice Address - Fax:559-452-8901
Is Sole Proprietor?:No
Enumeration Date:2011-10-15
Last Update Date:2011-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist