Healthcare Provider Details

I. General information

NPI: 1750804324
Provider Name (Legal Business Name): KEYAMBI LATANYA ROBINSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2017
Last Update Date: 07/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 LAKEWOOD DR
LULING LA
70070-6114
US

IV. Provider business mailing address

404 HONEYSUCKLE DR
NORCO LA
70079-2195
US

V. Phone/Fax

Practice location:
  • Phone: 985-206-6853
  • Fax:
Mailing address:
  • Phone: 504-231-1352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: