1518281625 NPI number — MISS LATONYA DENISE HITCHCOCK PA-C

Table of content: MISS LATONYA DENISE HITCHCOCK PA-C (NPI 1518281625)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518281625 NPI number — MISS LATONYA DENISE HITCHCOCK PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HITCHCOCK
Provider First Name:
LATONYA
Provider Middle Name:
DENISE
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518281625
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/31/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4221 S ALAMEDA ST
Provider Second Line Business Mailing Address:
SUITE 456
Provider Business Mailing Address City Name:
VERNON
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90058-1601
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
213-745-6047
Provider Business Mailing Address Fax Number:
213-748-9715

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1414 SOUTH GRAND AVENUE
Provider Second Line Business Practice Location Address:
SUITE 456
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90015-3017
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-745-6047
Provider Business Practice Location Address Fax Number:
213-748-9715
Provider Enumeration Date:
03/18/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AM0700X , with the licence number:  20753 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com