Healthcare Provider Details

I. General information

NPI: 1841871571
Provider Name (Legal Business Name): LATIAH PACE RCP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2021
Last Update Date: 04/15/2021
Certification Date: 04/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2221 FAIRWAY DR
FORT WORTH TX
76119-4562
US

IV. Provider business mailing address

2221 FAIRWAY DR
FORT WORTH TX
76119-4562
US

V. Phone/Fax

Practice location:
  • Phone: 956-407-8388
  • Fax:
Mailing address:
  • Phone: 956-407-8388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License NumberRCP02000058
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: