MEDICARE: LATARSHA MCCRIMMON

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	172A00000X	Driver	00803540	TX

General Provider Information

NPI Number	:	1568030955
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LATARSHA MCCRIMMON

Provider Business Mailing Address
First Line	:	7003 VILLA DEL SOL DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77083-2333
Country	:	US
Telephone Number	:	281-960-1391
Fax Number	:

Provider Business Practice Location Address
First Line	:	7003 VILLA DEL SOL DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77083-2333
Country	:	US
Telephone Number	:	281-960-1391
Fax Number	:

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

Provider Enumeration Date	:	06/14/2021
Last Update Date	:	06/14/2021

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Directions to “ LATARSHA MCCRIMMON ” Practice Location

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