Healthcare Provider Details

I. General information

NPI: 1881515534
Provider Name (Legal Business Name): LATOYA MONIQUE RANDOLPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1925 E DAKOTA AVE
FRESNO CA
93726-4821
US

IV. Provider business mailing address

1925 E DAKOTA AVE
FRESNO CA
93726-4821
US

V. Phone/Fax

Practice location:
  • Phone: 559-600-9180
  • Fax:
Mailing address:
  • Phone: 559-600-9180
  • Fax: 559-455-4783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code167G00000X
TaxonomyLicensed Psychiatric Technician
License Number41322
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: