MEDICARE: LATOYA TANISHA MARTIN

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	347C00000X	Private Vehicle

General Provider Information

NPI Number	:	1811735608
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LATOYA TANISHA MARTIN

Provider Business Mailing Address
First Line	:	3325 CHELSEA DR
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44118-1321
Country	:	US
Telephone Number	:	954-854-6516
Fax Number	:

Provider Business Practice Location Address
First Line	:	3325 CHELSEA DR
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44118-1321
Country	:	US
Telephone Number	:	954-854-6516
Fax Number	:

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

Provider Enumeration Date	:	07/17/2024
Last Update Date	:	07/17/2024

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Directions to “ LATOYA TANISHA MARTIN ” Practice Location

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