Healthcare Provider Details

I. General information

NPI: 1801131552
Provider Name (Legal Business Name): VARONECA LATHAM LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2012
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18296 SASSAFRAS LN
ARROWHEAD FARMS CA
92407-8969
US

IV. Provider business mailing address

18296 SASSAFRAS LN
ARROWHEAD FARMS CA
92407-8969
US

V. Phone/Fax

Practice location:
  • Phone: 909-480-6882
  • Fax:
Mailing address:
  • Phone: 909-480-6882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number161795
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: