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General NPI Number Information
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NPI Number | 1811406564
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Entity Type | Individual
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Provider Name | LATONYA ROUSE
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Gender | Female
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Dates
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Enumeration Date | 09/26/2017
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Last Update Date | 09/26/2017
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Provider Practice Location Address
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Address Line | 5214 VIA HACIENDA 206
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City | ORLANDO
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State | FL
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Zip | 32839
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Country | US
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Telephone | 321-437-2673
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Fax |
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Provider Business Mailing Address
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Address Line | 5214 VIA HACIENDA CIR APT 206
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City | ORLANDO
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State | FL
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Zip | 32839-2187
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Country | US
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Telephone | 13214372673
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Fax | 132-143-7267
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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 | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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