Healthcare Provider Details

I. General information

NPI: 1396316683
Provider Name (Legal Business Name): LATONYA L HADDAD NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2021
Last Update Date: 07/07/2021
Certification Date: 07/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 W RAYFORD RD APT 3201
SPRING TX
77389-2211
US

IV. Provider business mailing address

525 N SAM HOUSTON PKWY E STE 255
HOUSTON TX
77060-4017
US

V. Phone/Fax

Practice location:
  • Phone: 832-741-2474
  • Fax:
Mailing address:
  • Phone: 832-672-4739
  • Fax: 832-575-4999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number1011779
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: