Healthcare Provider Details

I. General information

NPI: 1518577717
Provider Name (Legal Business Name): MRS. LATOYA LILES-WALKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2020
Last Update Date: 02/07/2024
Certification Date: 02/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4248 BENNING RD NE
WASHINGTON DC
20019-4531
US

IV. Provider business mailing address

4248 BENNING RD NE
WASHINGTON DC
20019-4531
US

V. Phone/Fax

Practice location:
  • Phone: 202-748-5608
  • Fax:
Mailing address:
  • Phone: 202-498-1299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: