Healthcare Provider Details

I. General information

NPI: 1336428267
Provider Name (Legal Business Name): LATOYA LITTLES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2011
Last Update Date: 09/27/2022
Certification Date: 09/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3433 W SHAW AVE STE 107
FRESNO CA
93711-3229
US

IV. Provider business mailing address

3433 W SHAW AVE STE 107
FRESNO CA
93711-3229
US

V. Phone/Fax

Practice location:
  • Phone: 505-558-4051
  • Fax:
Mailing address:
  • Phone: 559-558-4051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: