Healthcare Provider Details

I. General information

NPI: 1568866093
Provider Name (Legal Business Name): LATOYA SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2014
Last Update Date: 10/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

934 E TIDWELL RD
HOUSTON TX
77022-1826
US

IV. Provider business mailing address

934 E TIDWELL RD
HOUSTON TX
77022-1826
US

V. Phone/Fax

Practice location:
  • Phone: 713-429-1810
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: