Healthcare Provider Details

I. General information

NPI: 1124682760
Provider Name (Legal Business Name): LATEIA S TAYLOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2019
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7675 WELLNESS WAY
WEST CHESTER OH
45069-2509
US

IV. Provider business mailing address

PO BOX 636256
CINCINNATI OH
45263-6256
US

V. Phone/Fax

Practice location:
  • Phone: 513-475-8588
  • Fax: 513-475-5498
Mailing address:
  • Phone: 513-585-6200
  • Fax: 513-245-3672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number35.151870
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: