Healthcare Provider Details

I. General information

NPI: 1225645278
Provider Name (Legal Business Name): LATOYIA IRVIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2020
Last Update Date: 09/24/2020
Certification Date: 09/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1517 SANTA ROSALIA DR
NORTH LAS VEGAS NV
89031-1010
US

IV. Provider business mailing address

1517 SANTA ROSALIA DR
NORTH LAS VEGAS NV
89031-1010
US

V. Phone/Fax

Practice location:
  • Phone: 702-929-3297
  • Fax:
Mailing address:
  • Phone: 702-929-3297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: