MEDICARE: MRS. LATORI DANIEL ABII PA

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA03341	TX

General Provider Information

NPI Number	:	1659631976
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LATORI DANIEL ABII PA

Provider Business Mailing Address
First Line	:	4300 COMMUNITY BLVD
Second Line	:	COLLIN COUNTY DETENTION FACILITY
City	:	MCKINNEY
State	:	TX
Zip	:	75071-2535
Country	:	US
Telephone Number	:	972-547-5288
Fax Number	:	972-547-5390

Provider Business Practice Location Address
First Line	:	4300 COMMUNITY BLVD
Second Line	:	COLLIN COUNTY DETENTION FACILITY
City	:	MCKINNEY
State	:	TX
Zip	:	75071-2535
Country	:	US
Telephone Number	:	972-547-5288
Fax Number	:	972-547-5390

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/21/2012
Last Update Date	:	05/21/2012

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