Healthcare Provider Details

I. General information

NPI: 1396234795
Provider Name (Legal Business Name): NATASHA LE MORVAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2018
Last Update Date: 05/30/2024
Certification Date: 05/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 PALMILLA RD NW STE A
LOS LUNAS NM
87031-4865
US

IV. Provider business mailing address

590 SHOAL CREEK DR
OCOEE FL
34761-3141
US

V. Phone/Fax

Practice location:
  • Phone: 505-856-6880
  • Fax:
Mailing address:
  • Phone: 407-802-0862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code156F00000X
TaxonomyTechnician/Technologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: