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General NPI Number Information
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NPI Number | 1528879210
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Entity Type | Individual
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Provider Name | LATASHA LATREVIEA LANE
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Gender | Female
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Dates
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Enumeration Date | 01/14/2025
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Last Update Date | 01/14/2025
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Provider Practice Location Address
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Address Line | 9050 PINES BLVD
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City | PEMBROKE PINES
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State | FL
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Zip | 33024-6455
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Country | US
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Telephone | 954-744-4182
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Fax |
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Provider Business Mailing Address
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Address Line | 3470 FOXCROFT RD APT 108
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City | MIRAMAR
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State | FL
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Zip | 33025-4162
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Country | US
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Telephone | 954-243-7638
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | 1086944
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License Number State | FL
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