Healthcare Provider Details

I. General information

NPI: 1134657166
Provider Name (Legal Business Name): LATISHA RUBY BLUE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2017
Last Update Date: 08/07/2024
Certification Date: 08/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 BRENTWOOD PKWY NE
WASHINGTON DC
20002-2220
US

IV. Provider business mailing address

1800 RYDERWOOD CT
LANDOVER MD
20785-3977
US

V. Phone/Fax

Practice location:
  • Phone: 202-871-8635
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: