MEDICARE: LATONYA NEAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1205396652
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LATONYA NEAL

Provider Business Mailing Address
First Line	:	17251 DANTE ST APT 2
Second Line	:
City	:	VICTORVILLE
State	:	CA
Zip	:	92394-1644
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8155 W CHARLESTON BLVD APT 107
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-1265
Country	:	US
Telephone Number	:	760-461-0432
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/21/2019
Last Update Date	:	03/21/2019

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Directions to “ LATONYA NEAL ” Practice Location

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