MEDICARE: LATESHA REED NURSE PRACTITIONER A NURSING CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	363LF0000X	Family Nurse Practitioner
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner
3	261QM0850X	Adult Mental Health Clinic/Center
4	261QM0855X	Adolescent and Children Mental Health Clinic/Center
5	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
6	261QP2300X	Primary Care Clinic/Center
7	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1588436844
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LATESHA REED NURSE PRACTITIONER A NURSING CORPORATION

Provider Business Mailing Address
First Line	:	400 CORPORATE POINTE
Second Line	:	STE 300
City	:	CULVER CITY
State	:	CA
Zip	:	90230
Country	:	US
Telephone Number	:	310-853-2395
Fax Number	:	203-902-0115

Provider Business Practice Location Address
First Line	:	5304 SENFORD AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90056-1027
Country	:	US
Telephone Number	:	310-853-2395
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. LATESHA TIFFANY REED
Credential	:	DNP, FNP, PMHNP
Telephone Number	:	310-853-2395

Provider Enumeration Date	:	10/30/2023
Last Update Date	:	10/28/2024

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