Healthcare Provider Details

I. General information

NPI: 1538081229
Provider Name (Legal Business Name): ALEXANDRA LATATE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8002 S MARSHFIELD AVE APT 2S
CHICAGO IL
60620-0535
US

IV. Provider business mailing address

8002 S MARSHFIELD AVE APT 2S
CHICAGO IL
60620-0535
US

V. Phone/Fax

Practice location:
  • Phone: 800-807-8524
  • Fax:
Mailing address:
  • Phone: 800-807-8524
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT148548
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number227022818
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: