Healthcare Provider Details

I. General information

NPI: 1497639967
Provider Name (Legal Business Name): LATRICE MARIE REID
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2025
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9211 AMYS ST APT 30
SPRING VALLEY CA
91977-3992
US

IV. Provider business mailing address

PO BOX 152533
SAN DIEGO CA
92195-2533
US

V. Phone/Fax

Practice location:
  • Phone: 619-800-8330
  • Fax:
Mailing address:
  • Phone: 619-302-8691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-310982
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: